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	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1013577675
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	:

Provider Business Practice Location Address
First Line	:	1580 32ND ST SW
Second Line	:
City	:	HICKORY
State	:	NC
Zip	:	28602-4633
Country	:	US
Telephone Number	:	828-324-8884
Fax Number	:	828-345-6226

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

Provider Enumeration Date	:	06/17/2019
Last Update Date	:	10/05/2020

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