Provider Demographics
NPI:1740529775
Name:FORSYTH MEMORIAL HOSPITAL INC
Entity type:Organization
Organization Name:FORSYTH MEMORIAL HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP & COO NOVANT MEDICAL GROUP
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANGFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-993-8181
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:336-643-3378
Mailing Address - Fax:336-643-3670
Practice Address - Street 1:7607-B HIGHWAY 68 NORTH
Practice Address - Street 2:
Practice Address - City:OAKRIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-8803
Practice Address - Country:US
Practice Address - Phone:336-643-3378
Practice Address - Fax:336-643-3670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC235045JMedicare PIN