Basic Information
| Provider Information | |||||||||
| NPI: | 1699732230 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FORSYTH CARDIOLOGY ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3073 TRENWEST DR | ||||||||
| Address2: | |||||||||
| City: | WINSTON SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271033207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367680437 | ||||||||
| FaxNumber: | 3367680433 | ||||||||
| Practice Location | |||||||||
| Address1: | 3073 TRENWEST DR | ||||||||
| Address2: | |||||||||
| City: | WINSTON-SALEM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 271033207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367680437 | ||||||||
| FaxNumber: | 3367680433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2006 | ||||||||
| LastUpdateDate: | 07/08/2008 | ||||||||
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| AuthorizedOfficialLastName: | CAGLE | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF QUALITY AND RISK OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 3368022406 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 01554 | 01 | NC | BCNC | OTHER | 4648908 | 01 | NC | AETNA | OTHER | CI0194 | 01 | NC | RAILROAD MEDICARE | OTHER | 8901554 | 05 | NC | MEDICAID |