Provider Demographics
NPI:1982732269
Name:SCHOOL HEALTH ALLIANCE FOR FORSYTH COUNTY
Entity Type:Organization
Organization Name:SCHOOL HEALTH ALLIANCE FOR FORSYTH COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-713-7188
Mailing Address - Street 1:MEDICAL CENTER BLVD
Mailing Address - Street 2:WFBH-SCHOOL HEALTH ALLIANCE
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-0001
Mailing Address - Country:US
Mailing Address - Phone:336-713-7188
Mailing Address - Fax:336-713-7183
Practice Address - Street 1:4555 OGBURN AVE
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105-2726
Practice Address - Country:US
Practice Address - Phone:336-703-4273
Practice Address - Fax:336-661-4954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6005804Medicaid
NC011N0OtherBLUE CROSS - BLUE SHIELD
NCA9495OtherMEDCOST