NPIMap

Organization Active NPI

West Forsyth Pain Management

  • Medical Physician Assistant
  • Clemmons, NC
National Provider Identifier
1053692079
Registry record updated Sep 3, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
101887 Issued in NC
Legal business name
WEST FORSYTH PAIN MANAGEMENT
Practice address
2554 Lewisville Clemmons Rd
Suite 211
Clemmons, NC 27012-8110
Phone
(336) 740-9444
Fax
(336) 740-9445
NPI assigned
Sep 3, 2011
Last updated
Sep 3, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Amanda Anne Zimmerman, PA-CNPI 1265525497
Title
Physician Assistant
Phone
(336) 740-9444

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X 101887 NC Primary

Addresses

Primary practice location

2554 Lewisville Clemmons Rd
Suite 211
Clemmons, NC 27012-8110

Mailing address

2554 Lewisville Clemmons Rd
Suite 211
Clemmons, NC 27012-8110
Phone (336) 740-9444

National Provider Directory

National Provider Directory

Locations

2554 Lewisville Clemmons Rd
Ste 112
Clemmons, NC 27012
Phone (336) 283-2510

2554 Lewisville Clemmons Rd
Ste 211
Clemmons, NC 27012
Phone (336) 740-9444

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1315008000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315008000000",
    "number": "1053692079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2554 LEWISVILLE CLEMMONS RD",
            "address_2": "SUITE 211",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128110",
            "telephone_number": "336-740-9444",
            "fax_number": "336-740-9445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2554 LEWISVILLE CLEMMONS RD",
            "address_2": "SUITE 211",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128110",
            "telephone_number": "336-740-9444",
            "fax_number": "336-740-9445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST FORSYTH PAIN MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-03",
        "last_updated": "2011-09-03",
        "status": "A",
        "authorized_official_last_name": "ZIMMERMAN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "336-740-9444",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "101887",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clemmons, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.