# FORSYTH MEMORIAL HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** FORSYTH MEMORIAL HOSPITAL, INC
- **Other names:** Friedburg Family Medicine
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1912051939
- **Legal business name:** FORSYTH MEMORIAL HOSPITAL, INC
- **Authorized official:** MICHELE GRIER (VP OPERATIONS)
- **Authorized official phone:** (336) 788-4664

## Contact information

- **Practice address:** 5010 PETERS CREEK PKWY, DBA FRIEDBURG FAMILY MEDICINE, WINSTON SALEM, NC 27127-7276
- **Practice address phone:** (336) 788-4664
- **Practice address fax:** (336) 788-0753
- **Mailing address:** 2000 FRONTIS PLAZA BLVD STE 102, FORSYTH MEDICAL GROUP, LLC, WINSTON SALEM, NC 27103-5616
- **Mailing address phone:** (336) 788-4664
- **Mailing address fax:** (336) 788-0753

## 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:** 01/23/2007
- **Last updated:** 08/14/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 019C9 | BCBS PIN | NC |
| 05 | — | 5906033 | — | NC |