# FORSYTH MEMORIAL HOSPITAL INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Novant Health Salem Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1912955089
- **Authorized official:** LEEA JEANINE WALTON (RCS MANAGER)
- **Authorized official phone:** (704) 316-6081

## Contact information

- **Practice address:** 105 VEST MILL CIR, WINSTON SALEM, NC 27103-2943
- **Practice address phone:** (336) 718-7800
- **Practice address fax:** (336) 718-7900
- **Mailing address:** PO BOX 751803, CHARLOTTE, NC 28275-1803
- **Mailing address phone:** (336) 718-7800
- **Mailing address fax:** (336) 718-7900

## 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:** 05/04/2006
- **Last updated:** 07/12/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 890258W | — | NC |
| 01 | — | CA1315 | RAILROAD MEDICARE | NC |