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	:	1952137473
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	:	704-874-1900
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 RENON RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-5030
Country	:	US
Telephone Number	:	336-703-4273
Fax Number	:

Authorized Official
Title or Position	:	REVENUE CYCLE MANAGER
Name	:	SHARMILA ALEXANDER ANDERSON
Credential	:
Telephone Number	:	704-874-1907

Provider Enumeration Date	:	09/11/2024
Last Update Date	:	09/11/2024

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