1902909328 NPI number — FORSYTH CARDIAC & VASCULAR SURGEONS, P.A.

Table of content: MICHAEL S. AUSMUS M.D. (NPI 1215954888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902909328 NPI number — FORSYTH CARDIAC & VASCULAR SURGEONS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORSYTH CARDIAC & VASCULAR SURGEONS, P.A.
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:
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:
1902909328
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4622 COUNTRY CLUB RD
Provider Second Line Business Mailing Address:
SUITE 180
Provider Business Mailing Address City Name:
WINSTON-SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27104-3770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-768-9535
Provider Business Mailing Address Fax Number:
336-768-4155

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4622 COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
SUITE 180
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27104-3770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-768-9535
Provider Business Practice Location Address Fax Number:
336-768-4155
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
AR & CREDENTIALING MANAGER
Authorized Official Telephone Number:
336-794-9616

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  40490 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 890127F , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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