NPIMap

Organization Active NPI

Gaston Family Health Services, Inc

Doing business as Kintegra Mobile Dentistry-North

  • Federally Qualified Health Center (FQHC)
  • Statesville, NC
National Provider Identifier
1205466398
Registry record updated Jan 17, 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-North
Practice address
518 Brookdale Dr
Statesville, NC 28677-4108
Phone
(704) 838-1108
Fax
(704) 671-1404
NPI assigned
Jan 17, 2020
Last updated
Jan 17, 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 Jan 17, 2020

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

518 Brookdale Dr
Statesville, NC 28677-4108

Mailing address

518 Brookdale Dr
Statesville, NC 28677-4108
Phone (704) 838-1108

Other names 1

  • Kintegra Mobile Dentistry-North 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 1205466398. Details of each certification follow.

  • CCN 341155 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 341155

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 NORTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Mar 27, 2020
Last certification
Mar 27, 2020
Ownership / control type
For profit – partnership
Facility address
518 Brookdale Drive
Statesville, NC 28677

National Provider Directory

National Provider Directory
Part of
Gaston Family Health SE

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": "1579219200000",
    "number": "1205466398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "518 BROOKDALE DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774108",
            "telephone_number": "704-838-1108",
            "fax_number": "704-671-1404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "518 BROOKDALE DR",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286774108",
            "telephone_number": "704-838-1108",
            "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": "2020-01-17",
        "certification_date": "2020-01-17",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "SHARMILA",
        "authorized_official_middle_name": "ALEXANDER",
        "authorized_official_title_or_position": "BUSINES SERVICE ADMINISTRATOR",
        "authorized_official_telephone_number": "704-874-1907"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kintegra Mobile Dentistry-North",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Statesville, NC

Sources for this page

Verify at the official NPI Registry.