Provider Demographics
NPI:1831376797
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:VP OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-277-2421
Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 102
Mailing Address - Street 2:NOVANT MEDICAL GROUP
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 1:121 MEDICAL DR
Practice Address - Street 2:DBA MEDICAL ASSOCIATES OF DAVIE - HILLSDALE
Practice Address - City:ADVANCE
Practice Address - State:NC
Practice Address - Zip Code:27006-6651
Practice Address - Country:US
Practice Address - Phone:336-998-9060
Practice Address - Fax:336-998-9061
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORSYTH MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC02054OtherBCBS GRP ID#
NC7902054Medicaid
NC7902054Medicaid