Provider Demographics
NPI:1093991051
Name:FORSYTH MEDICAL GROUP, LLC.
Entity Type:Organization
Organization Name:FORSYTH MEDICAL GROUP, LLC.
Other - Org Name:LEXINGTON PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-277-2421
Mailing Address - Street 1:PO BOX 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:704-716-4820
Mailing Address - Fax:
Practice Address - Street 1:110 W MEDICAL PARK DR
Practice Address - Street 2:DBA LEXINGTON PRIMARY CARE
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6773
Practice Address - Country:US
Practice Address - Phone:336-248-8692
Practice Address - Fax:336-249-7348
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORSYTH MEDICAL GROUP, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-21
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909121Medicaid
NC2344744Medicare PIN