Provider Demographics
NPI:1639297773
Name:FORSYTH BONE DENSITY IMAGING CENTER
Entity Type:Organization
Organization Name:FORSYTH BONE DENSITY IMAGING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-768-5355
Mailing Address - Street 1:1800 SOUTH HAWTHORNE ROAD
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-4047
Mailing Address - Country:US
Mailing Address - Phone:336-768-5355
Mailing Address - Fax:336-768-5121
Practice Address - Street 1:1800 SOUTH HAWTHORNE ROAD
Practice Address - Street 2:LOWER LEVEL
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-4047
Practice Address - Country:US
Practice Address - Phone:336-768-5355
Practice Address - Fax:336-768-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC773207RM1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RM1200XAllopathic & Osteopathic PhysiciansInternal MedicineMagnetic Resonance Imaging (MRI)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790176TMedicaid
NC19632OtherPARTNERS
2901094OtherUNITED HEALTH
NC0176TOtherBCBS
2901094OtherUNITED HEALTH
C82651Medicare UPIN