Healthcare Provider Details

I. General information

NPI: 1316994163
Provider Name (Legal Business Name): GASTON CARDIAC ANESTHESIS AND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 COURT DR
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

PO BOX 12752
GASTONIA NC
28052-0014
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2000
  • Fax:
Mailing address:
  • Phone: 704-864-8772
  • Fax: 704-866-7853

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: CECILIA A BOWERS
Title or Position: CORP BILLING MGR
Credential:
Phone: 704-864-8772