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Organization

SCHOOL HEALTH ALLIANCE FOR FORSYTH COUNTY

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TRACY BRADSHAW (OFFICE MANAGER)
(336) 713-7188
Entity
Organization

Contact information

Practice address
4555 OGBURN AVE, WINSTON SALEM, NC 27105-2726
(336) 703-4273
(336) 661-4954
Mailing address
MEDICAL CENTER BLVD, WFBH-SCHOOL HEALTH ALLIANCE, WINSTON SALEM, NC 27157-0001
(336) 713-7188
(336) 713-7183

Taxonomy

Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
261QS1000X
Student Health Clinic/Center

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
011N0
BLUE CROSS - BLUE SHIELD
NC
05
6005804
NC
01
A9495
MEDCOST
NC
Enumeration date
03/01/2007
Last updated
10/18/2016
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