1780642629 NPI number — FORSYTH MEMORIAL HOSPITAL INC

Table of content: DR. BRYAN JOSEPH MENGES D.O. (NPI 1245438779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780642629 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:
1780642629
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 751803
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28275-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-384-9144
Provider Business Mailing Address Fax Number:
704-417-1043

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6301 STADIUM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEMMONS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27012-8766
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-766-6473
Provider Business Practice Location Address Fax Number:
336-766-8909
Provider Enumeration Date:
05/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAVIS
Authorized Official First Name:
SHALA
Authorized Official Middle Name:
Authorized Official Title or Position:
RCS MGR
Authorized Official Telephone Number:
704-303-7517

Provider Taxonomy Codes

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

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

  • Identifier: 015AA . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 89015AA , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CA1315 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 106 . This is a "BLUE MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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