| Gaston Family Practice Pllc | |
|
2290 Remount Rd Gastonia NC 28054-4725 | |
| (704) 867-1402 | |
| (888) 720-2814 |
| Full Name | Gaston Family Practice Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 2290 Remount Rd, Gastonia, North Carolina |
| Authorized Official Name and Position | Derek Reed (ADMINISTRATION) |
| Authorized Official Contact | 7048671402 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaston Family Practice Pllc 2290 Remount Rd Gastonia NC 28054-4725 Ph: (704) 867-1402 | Gaston Family Practice Pllc 2290 Remount Rd Gastonia NC 28054-4725 Ph: (704) 867-1402 |
| NPI Number | 1316656481 |
|---|---|
| Provider Enumeration Date | 11/17/2022 |
| Last Update Date | 09/12/2024 |
| Medicare PECOS PAC ID | 2668844168 |
|---|---|
| Medicare Enrollment ID | O20230209001868 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316656481 | NPI | - | NPPES |
| 1629271440 | Medicaid | NC | |
| 1912930009 | Medicaid | NC | |
| 1306896147 | Medicaid | NC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Brian Edward Wysong |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912930009 PECOS PAC ID: 8628050432 Enrollment ID: I20070424000288 |
| Provider Name | Caroline Dove Stephens |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1629271440 PECOS PAC ID: 0648361378 Enrollment ID: I20070809000166 |
| Provider Name | Derek Michael Reed |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306896147 PECOS PAC ID: 2163517483 Enrollment ID: I20080728000206 |
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