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NPI Code Detail

MEDICARE: GASTON FAMILY HEALTH SERVICES, INC.

MEDICARE: GASTON FAMILY HEALTH SERVICES, INC.
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
1261QF0400XFederally Qualified Health Center (FQHC)

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
30136XOTHERNCBLUE CROSS NUMBER
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003935750
Entity Type Code : Organization
Provider Name (Legal Business Name) : GASTON FAMILY HEALTH SERVICES, INC.
Provider Business Mailing Address
First Line : 200 E 2ND AVE
Second Line :
City : GASTONIA
State : NC
Zip : 28052-4358
Country : US
Telephone Number : 704-874-1904
Fax Number : 704-864-7608
Provider Business Practice Location Address
First Line : 119 WEST PENNSYLVANIA AVENUE
Second Line :
City : BESSEMER CITY
State : NC
Zip : 28016-2635
Country : US
Telephone Number : 704-629-3465
Fax Number : 704-629-1355
Authorized Official
Title or Position : BUSINESS SERVICE ADMIN
Name : SHARMILA ALEXANDER ANDERSON
Credential :
Telephone Number : 704-874-1900
Provider Enumeration Date : 03/27/2007
Last Update Date : 10/06/2020

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