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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