Basic Information
| Provider Information | |||||||||
| NPI: | 1033677240 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GASTON FAMILY HEALTH SERVICES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 200 E 2ND AVE | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280524358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048741907 | ||||||||
| FaxNumber: | 7048672134 | ||||||||
| Practice Location | |||||||||
| Address1: | 137 ISLAND FORD RD | ||||||||
| Address2: | |||||||||
| City: | MAIDEN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286508735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8284282446 | ||||||||
| FaxNumber: | 8284288226 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/06/2019 | ||||||||
| LastUpdateDate: | 03/06/2019 | ||||||||
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| AuthorizedOfficialLastName: | ANDERSON | ||||||||
| AuthorizedOfficialFirstName: | SHARMILA | ||||||||
| AuthorizedOfficialMiddleName: | ALEXANDER | ||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS SERVICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7048741907 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GASTON FAMILY HEALTH SERVICES, INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.