# WINSTON-SALEM STATE UNIVERSITY

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WSSU Sports Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144649948
- **Authorized official:** MR. IAN MUSHINSKI ATC, LAT (HEAD ATHLETIC TRAINER)
- **Authorized official phone:** (336) 750-2597

## Contact information

- **Practice address:** 1250 S MLK JR DR, WINSTON SALEM, NC 27107-1370
- **Practice address phone:** (336) 750-2597
- **Mailing address:** 5050 SPRING VALLEY RD, DALLAS, TX 75244-3995
- **Mailing address phone:** (800) 555-9073
- **Mailing address fax:** (972) 367-3452

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QS1000X | Student Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/09/2014
- **Last updated:** 04/09/2014