NPIMap

Organization Active NPI

Gaston Family Health Services, Inc.

Doing business as Kintegra Mobile Dentistry-South

  • Federally Qualified Health Center (FQHC)
  • Lincolnton, NC
National Provider Identifier
1003446196
Registry record updated Mar 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GASTON FAMILY HEALTH SERVICES, INC.
Doing business as
Kintegra Mobile Dentistry-South
Practice address
212 Gamble Dr
Lincolnton, NC 28092-4421
Phone
(704) 853-5191
Fax
(704) 671-1404
NPI assigned
Jan 17, 2020
Last updated
Mar 16, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
GASTON FAMILY HEALTH SERVICES, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 16, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sharmila Alexander Anderson
Title
Business Service Administrator
Phone
(704) 874-1907

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

212 Gamble Dr
Lincolnton, NC 28092-4421

Mailing address

991 W Hudson Blvd
Gastonia, NC 28052-6430
Phone (704) 853-5191

Other names 1

  • Kintegra Mobile Dentistry-South Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003446196. Details of each certification follow.

  • CCN 341154 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 341154

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
KINTEGRA MOBILE DENTISTRY SOUTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Apr 6, 2020
Last certification
Apr 6, 2020
Ownership / control type
For profit – partnership
Facility address
212 Gamble Drive
Lincolnton, NC 28092

National Provider Directory

National Provider Directory
Part of
Gaston Family Health SVCS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1584316800000",
    "number": "1003446196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "991 W HUDSON BLVD",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280526430",
            "telephone_number": "704-853-5191",
            "fax_number": "704-671-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 GAMBLE DR",
            "city": "LINCOLNTON",
            "state": "NC",
            "postal_code": "280924421",
            "telephone_number": "704-853-5191",
            "fax_number": "704-671-1404"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GASTON FAMILY HEALTH SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GASTON FAMILY HEALTH SERVICES, INC",
        "enumeration_date": "2020-01-17",
        "last_updated": "2020-03-16",
        "certification_date": "2020-03-16",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "BUSINESS SERVICE ADMINISTRATOR",
        "authorized_official_telephone_number": "704-874-1907"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kintegra Mobile Dentistry-South",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kintegra Mobile Dentistry-South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lincolnton, NC

Sources for this page

Verify at the official NPI Registry.