Provider Demographics
NPI:1235316118
Name:FORSYTH MEDICAL GROUP, LLC.
Entity Type:Organization
Organization Name:FORSYTH MEDICAL GROUP, LLC.
Other - Org Name:NOVANT HEALTH PIEDMONT WOMEN'S 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:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-243-7054
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:336-243-7054
Mailing Address - Fax:336-243-2302
Practice Address - Street 1:108 W MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6773
Practice Address - Country:US
Practice Address - Phone:336-243-7054
Practice Address - Fax:336-243-2302
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORSYTH MEDICAL GROUP, LLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5909120Medicaid
NC5909120Medicaid