1588799811 NPI number — FORSYTH MEMORIAL HOSPITAL INC

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 1588799811 NPI number — FORSYTH MEMORIAL HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORSYTH MEMORIAL HOSPITAL INC
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:
1588799811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
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:
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:
207 OLD LEXINGTON RD
Provider Second Line Business Practice Location Address:
DBA INPATIENT PHYSICIANS OF DAVIDSON
Provider Business Practice Location Address City Name:
THOMASVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27360-3428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-472-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
EVERHART
Authorized Official First Name:
LYNN
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
336-277-2433

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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