Provider Demographics
NPI:1255338570
Name:ANSON REGIONAL MEDICAL SERVICES, INC
Entity type:Organization
Organization Name:ANSON REGIONAL MEDICAL SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MISS
Authorized Official - First Name:GWENDOLYN
Authorized Official - Middle Name:ELISE
Authorized Official - Last Name:REED
Authorized Official - Suffix:
Authorized Official - Credentials:CFO
Authorized Official - Phone:704-694-6700
Mailing Address - Street 1:203 SALISBURY ST
Mailing Address - Street 2:
Mailing Address - City:WADESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28170-2155
Mailing Address - Country:US
Mailing Address - Phone:704-694-6700
Mailing Address - Fax:704-694-5454
Practice Address - Street 1:203 SALISBURY ST
Practice Address - Street 2:
Practice Address - City:WADESBORO
Practice Address - State:NC
Practice Address - Zip Code:28170-2155
Practice Address - Country:US
Practice Address - Phone:704-694-6700
Practice Address - Fax:704-694-5454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89130A6Medicaid
NC130A6OtherBCBS PROV NUMBER
NC130A6OtherBCBS PROV NUMBER
NCH47542Medicare UPIN