1558329318 NPI number — FOUNDATION HEALTH SYSTEMS CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558329318 NPI number — FOUNDATION HEALTH SYSTEMS CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FOUNDATION HEALTH SYSTEMS CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558329318
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 FRONTIS PLAZA BLVD STE 200
Provider Second Line Business Mailing Address:
(ATTN) FORSYTH MEDICAL GROUP
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27103-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-277-2435
Provider Business Mailing Address Fax Number:
336-277-9275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 GATEWAY CENTER DR
Provider Second Line Business Practice Location Address:
DBA EDWIN H. MARTINAT
Provider Business Practice Location Address City Name:
KERNERSVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27284-2999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-996-7001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LINER
Authorized Official First Name:
SALLYE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXE.VP & CCO & ADMIN
Authorized Official Telephone Number:
336-718-2004

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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