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	:	1053951756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTON FAMILY HEALTH SERVICES, INC

Provider Business Mailing Address
First Line	:	991 W HUDSON BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-6430
Country	:	US
Telephone Number	:	704-853-5191
Fax Number	:

Provider Business Practice Location Address
First Line	:	32 KIRKWOOD AVE
Second Line	:
City	:	LEXINGTON
State	:	NC
Zip	:	27292-4024
Country	:	US
Telephone Number	:	336-243-3201
Fax Number	:	704-671-1404

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

Provider Enumeration Date	:	01/10/2020
Last Update Date	:	02/18/2020

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