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2721 X Ray Dr Gastonia NC 28054-7491 | |
| (704) 874-2255 | |
| (704) 852-4092 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 2721 X Ray Dr, Gastonia, North Carolina |
| Authorized Official Name and Position | Sharmila Alexander Anderson (BUSINESS SERVICES ADMINISTRATOR) |
| Authorized Official Contact | 7048741907 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
200 E 2nd Ave Gastonia NC 28052-4358 Ph: (704) 874-1904 | 2721 X Ray Dr Gastonia NC 28054-7491 Ph: (704) 874-2255 |
| NPI Number | 1477079283 |
|---|---|
| Provider Enumeration Date | 08/15/2017 |
| Last Update Date | 01/15/2020 |
| Medicare PECOS PAC ID | 5496733925 |
|---|---|
| Medicare Enrollment ID | O20170926001002 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477079283 | NPI | - | NPPES |
| 1477079283 | Medicaid | NC | |
| 2171517 | Other | PK |
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