Organization
GASTON FAMILY HEALTH SERVICES INC
Active
Parent organization
GASTON FAMILY HEALTH SERVICES INC
Other names
Kintegra Family Medicine - Statesville
Organization subpart
Yes
Provider details
NPI number
Legal business name
GASTON FAMILY HEALTH SERVICES INC
Authorized official
SHARMILA ALEXANDER ANDERSON (BUSINESS SERVICE ADMIN)
(704) 874-1907
Entity
Organization
Contact information
Practice address
1022 SHELTON AVE, STATESVILLE, NC 28677-6826
(704) 838-1234
(704) 768-2081
Mailing address
1022 SHELTON AVE, STATESVILLE, NC 28677-6826
(704) 768-2080
(704) 768-2085
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0497686
—
NC
01
—
3409807
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
09/28/2007
Last updated
02/01/2021
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