Provider Demographics
NPI:1710549118
Name:GASTON FAMILY HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:GASTON FAMILY HEALTH SERVICES, INC.
Other - Org Name:KINTEGRA AT TRYON ELEMENTARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS SERVICES ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARMILA
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-874-1907
Mailing Address - Street 1:200 E 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-4358
Mailing Address - Country:US
Mailing Address - Phone:704-874-1904
Mailing Address - Fax:
Practice Address - Street 1:2620 TRYON COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:BESSEMER CITY
Practice Address - State:NC
Practice Address - Zip Code:28016-7646
Practice Address - Country:US
Practice Address - Phone:704-836-9107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTON FAMILY HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-07-05
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)