Forsyth Memorial Hospital Inc
Organization Active NPI Family Medicine Physician · Pilot Mountain, NC
NPI 1043338486 · NPPES record last updated Aug 14, 2008
Key facts
- NPI
- 1043338486
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- FORSYTH MEMORIAL HOSPITAL INC
- Practice address
- 207 Medical Street
Dba Pilot Mountain Family Practice
Pilot Mountain, NC 27041-8656 - Phone
- (336) 368-5011
- Fax
- (336) 368-1424
- NPI assigned
- Mar 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Michele Grier
- Title
- VP Operations
- Phone
- (336) 368-5011
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040405001702 | NC | Part B Supplier - Clinic/Group Practice | 9537071790 |
Receives reassigned benefits from 1,329 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X |
Addresses
Primary practice location
207 Medical Street
Dba Pilot Mountain Family Practice
Pilot Mountain, NC 27041-8656
Mailing address
2000 Frontis Plaza Blvd Ste 102
(Attn) Forsyth Medical Group
Winston Salem, NC 27103-5616
Phone (336) 368-5011
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 890239J | Medicaid | NC |
Other names
- Pilot Mountain Family Practice
Other providers in Pilot Mountain, NC
- Joseph Michael Carpenter
- Vanessa Renee Church
- Steven Collins
- Glenna Jeanine Daniels
- Amanda Boles Draughn
- Forsyth Memorial Hospital Inc
- Donna Goins
- Harrison Therapy, PLLC
- Michelle Hiatt
- Lee Ann Holland
All providers in Pilot Mountain, NC · Family Medicine Physician in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 14, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.