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NPI Code Detail

MEDICARE: FORSYTH MEMORIAL HOSPITAL INC

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
1207Q00000XFamily Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3CA1315OTHERNCRAILROAD MEDICARE
4106OTHERNCBLUE MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1015AAOTHERNCBLUECROSS BLUESHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780642629
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 : 704-384-9144
Fax Number : 704-417-1043
Provider Business Practice Location Address
First Line : 6301 STADIUM DR
Second Line :
City : CLEMMONS
State : NC
Zip : 27012-8766
Country : US
Telephone Number : 336-766-6473
Fax Number : 336-766-8909
Authorized Official
Title or Position : RCS MGR
Name : SHALA DAVIS
Credential :
Telephone Number : 704-303-7517
Provider Enumeration Date : 05/02/2006
Last Update Date : 08/18/2021

Similar Medicare Providers

1366446320 — CHRISTOPHER ANDREW MADDEN M.D.
Practice Location Address:
6301 STADIUM DR
CLEMMONS, NC
27012-8766
Practice Phone: 336-766-6473
Practice Fax: 336-766-8909
1992787501 — MRS. DANIELLE MARGUERITE CARTER ADKINS PA-C
Practice Location Address:
6301 STADIUM DR STE 500
CLEMMONS, NC
27012-8766
Practice Phone: 336-766-6473
Practice Fax: 336-766-8909
1326028382 — TERRY MICHAEL DEAKLE PA
Practice Location Address:
6301 STADIUM DR
CLEMMONS, NC
27012-8766
Practice Phone: 336-766-6473
Practice Fax: 336-766-8909
1609835396 — DEBORAH H POLLOCK MD
Practice Location Address:
6301 STADIUM DR
CLEMMONS, NC
27012-8766
Practice Phone: 336-766-6473
Practice Fax: 336-766-8909
1629039870 — WALTER H WRAY MD
Practice Location Address:
6301 STADIUM DR
CLEMMONS, NC
27012-8766
Practice Phone: 336-766-6473
Practice Fax: 336-766-8909
1992762538 — MRS. MARY DEAKLE PA-C
Practice Location Address:
6301 STADIUM DR
CLEMMONS, NC
27012-8766
Practice Phone: 336-766-6473
Practice Fax: 336-766-8909

Directions to “FORSYTH MEMORIAL HOSPITAL INC ” Practice Location

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