NPIMap

Organization Active NPI

Winston-Salem State University

  • Student Health Clinic/Center
  • Winston Salem, NC
National Provider Identifier
1851713374
Registry record updated Jan 17, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student Health Clinic/CenterTaxonomy code 261QS1000X
Legal business name
WINSTON-SALEM STATE UNIVERSITY
Practice address
601 S Martin Luther King Jr Dr
A.H. Ray BLDG RM. 244
Winston Salem, NC 27110-0001
Phone
(336) 750-3301
Fax
(336) 750-3303
NPI assigned
Jan 17, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anthony Philadelphia, PHD.
Title
Director
Phone
(336) 750-3274

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X
Student Health Clinic/Center 261QS1000X Primary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X

Addresses

Primary practice location

601 S Martin Luther King Jr Dr
A.H. Ray BLDG RM. 244
Winston Salem, NC 27110-0001

Mailing address

601 S Martin Luther King Jr Dr
A.H. Ray BLDG RM. 244
Winston Salem, NC 27110-0001
Phone (336) 750-3301

Other identifiers 1

IdentifierTypeStateIssuer
7000169MedicaidNC

Other names 1

  • Wellness Ctr. Student Blue Other name

National Provider Directory

National Provider Directory
Tax ID family
Winston-Salem State University4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1389916800000",
    "number": "1851713374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 S MARTIN LUTHER KING JR DR",
            "address_2": "A.H. RAY BLDG RM. 244",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271100001",
            "telephone_number": "336-750-3301",
            "fax_number": "336-750-3303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 S MARTIN LUTHER KING JR DR",
            "address_2": "A.H. RAY BLDG RM. 244",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271100001",
            "telephone_number": "336-750-3301",
            "fax_number": "336-750-3303"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WINSTON-SALEM STATE UNIVERSITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-17",
        "last_updated": "2014-01-17",
        "status": "A",
        "authorized_official_last_name": "PHILADELPHIA",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "336-750-3274",
        "authorized_official_credential": "PHD."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QS1000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Student Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7000169",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wellness Ctr. Student Blue",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Winston Salem, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.