Provider Demographics
NPI:1649239641
Name:MDCO PA
Entity Type:Organization
Organization Name:MDCO PA
Other - Org Name:NORTH POINT MEDICAL ASSOCIATES; WEST FORSYTH FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-759-7596
Mailing Address - Street 1:1995 BETHABARA RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-3375
Mailing Address - Country:US
Mailing Address - Phone:336-759-7596
Mailing Address - Fax:
Practice Address - Street 1:1995 BETHABARA RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-3375
Practice Address - Country:US
Practice Address - Phone:336-245-0333
Practice Address - Fax:336-245-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9500876207Q00000X
NC24445207Q00000X
NC9500759207Q00000X
NC95-00876207R00000X, 208000000X
NC95-00759207R00000X, 208000000X
NC102304363AM0700X
NC101788363AM0700X
NC101138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0222VOtherNORTH POINT MEDICAL BCBS
3977OtherPARTNERS WEST FORSYTH
NC0296WOtherWEST FORSYTH FAMILY BCBS
402116OtherUNITED HEALTHCARE WARNMNT
3981OtherPARTNERS NORTH POINT
402121OtherUNITED HEALTHCARE DALTON
287314OtherMAMSI LENDLE
CN3058OtherNP RAILROAD MCR
330206OtherLAB NP & WF
NC890222VMedicaid
NC890296WMedicaid
CJ5710OtherRAILROAD WF MEDICARE
102267OtherUNITED HEALTHCARE LENDLE
NC0222VOtherNORTH POINT MEDICAL BCBS
402116OtherUNITED HEALTHCARE WARNMNT
NC0296WOtherWEST FORSYTH FAMILY BCBS
330206OtherLAB NP & WF
C85116Medicare UPIN
F39661Medicare UPIN
NC890296WMedicaid