MEDICARE: FORSYTH MEMORIAL HOSPITAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	2688	OTHER	NC	BLUE MEDICARE
3	CA1315	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01126	OTHER	NC	BLUECROSS BLUESHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427006451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORSYTH MEMORIAL HOSPITAL INC

Provider Business Mailing Address
First Line	:	PO BOX 751803
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28275-1803
Country	:	US
Telephone Number	:	336-764-2324
Fax Number	:	336-764-9541

Provider Business Practice Location Address
First Line	:	12208 N NC HIGHWAY 150
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-9730
Country	:	US
Telephone Number	:	336-764-2324
Fax Number	:	336-764-9541

Authorized Official
Title or Position	:	RCS MANAGER
Name	:	LEEA JEANINE WALTON
Credential	:
Telephone Number	:	704-316-6081

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	07/10/2023

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Directions to “FORSYTH MEMORIAL HOSPITAL INC ” Practice Location

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