# FORSYTH MEMORIAL HOSPITAL INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pilot Mountain Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043338486
- **Authorized official:** MICHELE GRIER (VP OPERATIONS)
- **Authorized official phone:** (336) 368-5011

## Contact information

- **Practice address:** 207 MEDICAL STREET, DBA PILOT MOUNTAIN FAMILY PRACTICE, PILOT MOUNTAIN, NC 27041-8656
- **Practice address phone:** (336) 368-5011
- **Practice address fax:** (336) 368-1424
- **Mailing address:** 2000 FRONTIS PLAZA BLVD STE 102, (ATTN) FORSYTH MEDICAL GROUP, WINSTON SALEM, NC 27103-5616
- **Mailing address phone:** (336) 368-5011
- **Mailing address fax:** (336) 368-1424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |
| 363L00000X | Nurse Practitioner | — | NULL | — |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 03/26/2007
- **Last updated:** 08/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 890239J | — | NC |