# FORSYTH MEMORIAL HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FORSYTH MEMORIAL HOSPITAL, INC
- **Other names:** Medical Associates of Surry
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1598723488
- **Legal business name:** FORSYTH MEMORIAL HOSPITAL, INC
- **Authorized official:** JEFFERY LINDSAY (PRESIDENT OF FMC)
- **Authorized official phone:** (336) 718-2056

## Contact information

- **Practice address:** 865 W LAKE DR, MOUNT AIRY, NC 27030-2157
- **Practice address phone:** (336) 719-6100
- **Practice address fax:** (336) 719-2313
- **Mailing address:** 1718 E 4TH ST, SUITE 902, CHARLOTTE, NC 28204-3261
- **Mailing address phone:** (336) 719-6100
- **Mailing address fax:** (336) 719-2313

## Taxonomy

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

## Other

- **Enumeration date:** 05/02/2006
- **Last updated:** 08/24/2010

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5902732 | — | NC |
| 01 | — | CA1315 | RAILROAD MEDICARE | NC |