| Kintegra/sha At Mineral Springs | |
|
4555 Ogburn Ave Winston Salem NC 27105-2726 | |
| (336) 703-4273 | |
| (336) 661-4954 |
| Full Name | Kintegra/sha At Mineral Springs |
|---|---|
| Speciality | Clinic/Center |
| Location | 4555 Ogburn Ave, Winston Salem, North Carolina |
| Authorized Official Name and Position | Sharmila Anderson (BUSINESS SERVICES ADMINISTRATOR) |
| Authorized Official Contact | 7048741907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kintegra/sha At Mineral Springs 200 E 2nd Ave Gastonia NC 28052-4358 Ph: (704) 874-1904 | Kintegra/sha At Mineral Springs 4555 Ogburn Ave Winston Salem NC 27105-2726 Ph: (336) 703-4273 |
| NPI Number | 1154453496 |
|---|---|
| Provider Enumeration Date | 03/12/2007 |
| Last Update Date | 01/15/2020 |
| Medicare PECOS PAC ID | 5496733925 |
|---|---|
| Medicare Enrollment ID | O20170310001033 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154453496 | NPI | - | NPPES |
| 89011N0 | Medicaid | NC | |
| 8701701 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
| 261QS1000X | Clinic/center - Student Health | (* (Not Available)) | Secondary |
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