Provider Demographics
NPI:1346487964
Name:FORSYTHE MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:FORSYTHE MEMORIAL HOSPITAL, INC
Other - Org Name:MAPLEWOOD FAMILY PRACTICE AT THE VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP/COO
Authorized Official - Prefix:MS
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 1:5110 ROBINHOOD VILLAGE DR
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5476
Mailing Address - Country:US
Mailing Address - Phone:336-718-0800
Mailing Address - Fax:336-718-0871
Practice Address - Street 1:5110 ROBINHOOD VILLAGE DR
Practice Address - Street 2:SUITE C-1
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5476
Practice Address - Country:US
Practice Address - Phone:336-718-0800
Practice Address - Fax:336-718-0871
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-20
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty