Provider Demographics
NPI:1598890733
Name:GASTON CARDIAC ANETHESIS AND
Entity Type:Organization
Organization Name:GASTON CARDIAC ANETHESIS AND
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORP BILLING MGR
Authorized Official - Prefix:
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:CPC
Authorized Official - Phone:704-864-8772
Mailing Address - Street 1:PO BOX 12752
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-0014
Mailing Address - Country:US
Mailing Address - Phone:704-864-8772
Mailing Address - Fax:704-866-7853
Practice Address - Street 1:2525 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-834-2825
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8000289Medicaid
NC2617284Medicare ID - Type Unspecified