Provider Demographics
NPI:1831875400
Name:GASTON FAMILY HEALTH SERVICES, INC.
Entity type:Organization
Organization Name:GASTON FAMILY HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
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:
Mailing Address - Fax:
Practice Address - Street 1:642 HIGHWAY 274
Practice Address - Street 2:
Practice Address - City:VALE
Practice Address - State:NC
Practice Address - Zip Code:28168-7435
Practice Address - Country:US
Practice Address - Phone:704-276-2479
Practice Address - Fax:704-276-3378
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GASTON FAMILY HEALTH SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)