Provider Demographics
NPI:1043250350
Name:FORSYTH COUNTY
Entity Type:Organization
Organization Name:FORSYTH COUNTY
Other - Org Name:FORSYTH COUNTY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COUNTY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GRAHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:PERVIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-703-2020
Mailing Address - Street 1:911 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27101-4321
Mailing Address - Country:US
Mailing Address - Phone:336-703-2770
Mailing Address - Fax:336-727-8088
Practice Address - Street 1:911 E 5TH ST
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27101-4321
Practice Address - Country:US
Practice Address - Phone:336-703-2770
Practice Address - Fax:336-727-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2009-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8585Medicaid
278036Medicare ID - Type Unspecified