Provider Demographics
NPI:1902075187
Name:FORSYTH MEMORIAL HOSPITAL, INC
Entity Type:Organization
Organization Name:FORSYTH MEMORIAL HOSPITAL, INC
Other - Org Name:RHEUMATOLOGY & ARTHRITIS ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO & EXECUTIVE VP
Authorized Official - Prefix:
Authorized Official - First Name:PATIRCK
Authorized Official - Middle Name:
Authorized Official - Last Name:EASTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-384-9094
Mailing Address - Street 1:2000 FRONTIS PLAZA BLVD STE 102
Mailing Address - Street 2:NOVANT MEDICAL GROUP
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-5616
Mailing Address - Country:US
Mailing Address - Phone:336-277-2435
Mailing Address - Fax:336-277-9275
Practice Address - Street 1:291 BROAD ST
Practice Address - Street 2:DBA RHEUMATOLOGY & ARTHRITIS ASSOCIATES
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-2932
Practice Address - Country:US
Practice Address - Phone:336-718-7810
Practice Address - Fax:336-718-9374
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORSYTH MEMORIAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty