Organization
GASTON FAMILY HEALTH SERVICES, INC.
Active
Parent organization
GASTON FAMILY HEALTH SERVICES, INC
Other names
Kintegra Family Medicine - Hudson
Organization subpart
Yes
Provider details
NPI number
Legal business name
GASTON FAMILY HEALTH SERVICES, INC
Authorized official
SHARMILA ALEXANDER ANDERSON (BUSINESS SERVICE ADMINISTRATOR)
(704) 874-1907
Entity
Organization
Contact information
Practice address
991 WEST HUDSON BOULEVARD, GASTONIA, NC 28052-6430
(704) 853-5079
Mailing address
200 E 2ND AVE, GASTONIA, NC 28052-4358
(704) 874-1904
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0136X
BLUE CROSS NUMBER
NC
05
—
344574A
—
NC
01
—
611963200
BLACK LUNG PROGRAM
NC
05
—
NPB239
—
SC
Enumeration date
06/16/2005
Last updated
01/15/2020
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