Organization
FORSYTH MEMORIAL HOSPITAL INC
Active
Organization
FORSYTH MEMORIAL HOSPITAL INC
Active
Other names
Novant Health Premier Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
LEEA JEANINE WALTON (EDI MANAGER)
(704) 316-6081
Entity
Organization
Contact information
Practice address
3333 BROOKVIEW HILLS BLVD, SUITE 204, WINSTON SALEM, NC 27103-5661
(336) 774-3740
(336) 774-3780
Mailing address
PO BOX 751803, CHARLOTTE, NC 28275-1803
(336) 774-3740
(336) 774-3780
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
—
—
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015TK
GROUP BCBS NUMBER
NC
01
—
02570
GROUP AETNA NUMBER
NC
01
—
2452425
GROUP UHC NUMBER
NC
05
—
CA89015TK
—
NC
Enumeration date
01/23/2006
Last updated
07/11/2023
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