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
1	213E00000X	Podiatrist
2	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	34D1048048	OTHER	NC	CLIA WAIVER
2	0136X	OTHER	NC	BLUE CROSS NUMBER

General Provider Information

NPI Number	:	1548389125
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	:	704-871-1904
Fax Number	:	704-864-7608

Provider Business Practice Location Address
First Line	:	111 E 3RD AVE
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-4343
Country	:	US
Telephone Number	:	704-874-3300
Fax Number	:	704-874-0065

Authorized Official
Title or Position	:	BUSINESS SERVICE ADMINISTRATOR
Name	:	SHARMILA ALEXANDER ANDERSON
Credential	:
Telephone Number	:	704-874-1907

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	01/22/2026

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