Provider Demographics
NPI:1679531560
Name:FORSYTH MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:FORSYTH MEMORIAL HOSPITAL INC
Other - Org Name:NOVANT HEALTH FORSYTH NEUROLOGY
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:704-384-9144
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:704-384-9144
Mailing Address - Fax:704-417-1043
Practice Address - Street 1:2025 FRONTIS PLAZA BLVD
Practice Address - Street 2:STE 120
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-5663
Practice Address - Country:US
Practice Address - Phone:336-277-2200
Practice Address - Fax:336-277-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015FPMedicaid
NCCA1315OtherRAILROAD MEDICARE
NC235045VMedicare PIN