Organization
GASTON FAMILY HEALTH SERVICES INC
Active
Parent organization
GASTON FAMILY HEALTH SERVICES INC
Other names
Kintegra Adult & Pediatric Medicine - Xray Dr
Organization subpart
Yes
Provider details
NPI number
Legal business name
GASTON FAMILY HEALTH SERVICES INC
Authorized official
SHARMILA ALEXANDER ANDERSON (BUSINESS SERVICES ADMINISTRATOR)
(704) 874-1907
Entity
Organization
Contact information
Practice address
2721 X RAY DR, GASTONIA, NC 28054-7491
(704) 874-2255
(704) 852-4092
Mailing address
200 E 2ND AVE, GASTONIA, NC 28052-4358
(704) 874-1904
(704) 864-7608
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
13352
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1477079283
—
NC
01
—
2171517
PK
—
Enumeration date
08/15/2017
Last updated
01/15/2020
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