Provider Demographics
NPI:1700911278
Name:FORSYTH MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:FORSYTH MEMORIAL HOSPITAL INC
Other - Org Name:FORSYTH INTERNAL MEDICINE - KERNERSVILLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVERHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-277-2433
Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 200
Mailing Address - Street 2:FORSYTH MEDICAL GROUP LLC
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2435
Mailing Address - Fax:336-277-9275
Practice Address - Street 1:280 BROAD ST STE 280D
Practice Address - Street 2:FORSYTH INTERNAL MEDICINE - KERNERSVILLE
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2796
Practice Address - Country:US
Practice Address - Phone:336-993-2128
Practice Address - Fax:336-993-5282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Not Answered363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty