MEDICARE: NC SCHOOL OF ARTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QS1000X	Student Health Clinic/Center	03822	NC

General Provider Information

NPI Number	:	1093868242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NC SCHOOL OF ARTS

Provider Business Mailing Address
First Line	:	1533 S MAIN ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-2738
Country	:	US
Telephone Number	:	336-770-3288
Fax Number	:

Provider Business Practice Location Address
First Line	:	1533 S MAIN ST
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-2738
Country	:	US
Telephone Number	:	336-770-3288
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	MRS. ANN BARTZ POTTER
Credential	:	FNP
Telephone Number	:	336-770-3288

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/28/2008

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