Healthcare Provider Details

I. General information

NPI: 1508234402
Provider Name (Legal Business Name): FORSYTH MEMORIAL HOSPTIAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2015
Last Update Date: 09/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BALDWIN LN
WINSTON SALEM NC
27103-5846
US

IV. Provider business mailing address

PO BOX 751803
CHARLOTTE NC
28275-1803
US

V. Phone/Fax

Practice location:
  • Phone: 336-277-6080
  • Fax:
Mailing address:
  • Phone: 336-277-6080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License Number2010-00618
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number2010-00618
License Number StateNC

VIII. Authorized Official

Name: GEOFFREY K GARDNER
Title or Position: VP NMG FINANCE
Credential:
Phone: 336-277-6080