Provider Demographics
NPI:1326277062
Name:FORSYTH MEMORIAL HOSPITAL INC.
Entity Type:Organization
Organization Name:FORSYTH MEMORIAL HOSPITAL INC.
Other - Org Name:NOVANT HEALTH NEW GARDEN MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP & COO NOVANT MEDICAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-384-7606
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:336-288-8857
Mailing Address - Fax:336-288-8769
Practice Address - Street 1:1941 NEW GARDEN RD
Practice Address - Street 2:SUITE 216
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-2555
Practice Address - Country:US
Practice Address - Phone:336-288-8857
Practice Address - Fax:336-288-8769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-02
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5950709Medicaid
NC1326277062OtherBCBS
NC5950709Medicaid