1831439637 NPI number — SCHOOL HEALTH ALLIANCE FOR FORSYTH COUNTY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831439637 NPI number — SCHOOL HEALTH ALLIANCE FOR FORSYTH COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCHOOL HEALTH ALLIANCE FOR FORSYTH COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831439637
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
WFBH ATTN: TRACY BRADSHAW
Provider Business Mailing Address City Name:
WINSTON SALEM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27157-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-713-7188
Provider Business Mailing Address Fax Number:
336-713-7183

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4555 OGBURN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINSTON SALEM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27105-2726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-661-4952
Provider Business Practice Location Address Fax Number:
336-661-4954
Provider Enumeration Date:
02/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
BRADSHAW
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
336-713-7188

Provider Taxonomy Codes

  • Taxonomy code: 261QS1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89011N0 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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