Healthcare Provider Details

I. General information

NPI: 1992840003
Provider Name (Legal Business Name): ANSON REGIONAL MEDICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SALISBURY ST
WADESBORO NC
28170-2155
US

IV. Provider business mailing address

PO BOX 192 203 SALISBURY STREET
WADESBORO NC
28170-0192
US

V. Phone/Fax

Practice location:
  • Phone: 704-694-6700
  • Fax: 704-695-1227
Mailing address:
  • Phone: 704-694-6700
  • Fax: 704-694-5454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MS. GWENDOLYN REED
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MPA,RHIT
Phone: 704-694-6700