Provider Demographics
NPI:1144400698
Name:FORSYTH MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:FORSYTH MEMORIAL HOSPITAL, INC
Other - Org Name:PIEDMONT MEDICAL SPECIALIST (PCP)
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:336-718-0480
Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2435
Mailing Address - Fax:336-277-9275
Practice Address - Street 1:1381 WESTGATE CENTER DR
Practice Address - Street 2:DBA PIEDMONT MEDICAL SPECIALIST - PCP
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-2934
Practice Address - Country:US
Practice Address - Phone:336-718-0480
Practice Address - Fax:336-718-0484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORSYTH MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-13
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0167YOtherBCBS PIN - PCP
NCCA1315OtherRAILROAD MEDICARE