Healthcare Provider Details

I. General information

NPI: 1912051939
Provider Name (Legal Business Name): FORSYTH MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5010 PETERS CREEK PKWY DBA FRIEDBURG FAMILY MEDICINE
WINSTON SALEM NC
27127-7276
US

IV. Provider business mailing address

2000 FRONTIS PLAZA BLVD STE 102 FORSYTH MEDICAL GROUP, LLC
WINSTON SALEM NC
27103-5616
US

V. Phone/Fax

Practice location:
  • Phone: 336-788-4664
  • Fax: 336-788-0753
Mailing address:
  • Phone: 336-788-4664
  • Fax: 336-788-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELE GRIER
Title or Position: VP OPERATIONS
Credential:
Phone: 336-788-4664