OrganizationForsyth Memorial Hospital Inc(<Unavail>)Internal MedicineAllopathic & Osteopathic PhysiciansPractice Address3333 Brookview Hills Blvd, Suite 204, Winston Salem, NC 27103-5661(336) 774-3740PECOS EnrollmentBased on the most recent information from CMS, provider Forsyth Memorial Hospital Inc does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1851371066Provider TypeOrganizationFull NameForsyth Memorial Hospital IncOther Name<Unavail>SubpartNoEnumeration Date1/23/2006Last Updated7/11/2023Contact InformationPractice LocationPractice Address3333 Brookview Hills Blvd, Suite 204, Winston Salem, NC 27103-5661Phone(336) 774-3740Fax(336) 774-3780Mailing LocationMailing AddressPO Box 751803, Charlotte, NC 28275-1803Phone(336) 774-3740Fax(336) 774-3780Authorized OfficialNameWalton, Leea Jeanine (Edi Manager)Phone(704) 316-6081Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode207N00000XDescriptionDermatologyAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode363L00000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerCode207Q00000XDescriptionFamily MedicineAllopathic & Osteopathic PhysiciansLicenseUnlisted IssuerCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerProvider IdentifiersIDDescriptionIssuerID015TKDescriptionOtherIssuerGROUP BCBS NUMBERNorth CarolinaID2452425DescriptionOtherIssuerGROUP UHC NUMBERNorth CarolinaID02570DescriptionOtherIssuerGROUP AETNA NUMBERNorth CarolinaIDCA89015TKDescriptionMedicaidIssuerUnlistedNorth Carolina