Provider Demographics
NPI:1912051939
Name:FORSYTH MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:FORSYTH MEMORIAL HOSPITAL, INC
Other - Org Name:FRIEDBURG FAMILY MEDICINE
Other - Org Type:Doing Business As
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:336-788-4664
Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 102
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:336-788-4664
Mailing Address - Fax:336-788-0753
Practice Address - Street 1:5010 PETERS CREEK PKWY
Practice Address - Street 2:DBA FRIEDBURG FAMILY MEDICINE
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27127-7276
Practice Address - Country:US
Practice Address - Phone:336-788-4664
Practice Address - Fax:336-788-0753
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORSYTH MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2008-08-14
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
NC019C9OtherBCBS PIN
NC5906033Medicaid
NC019C9OtherBCBS PIN