| Eastridge Family Medicine | |
|
1896 Remount Rd Gastonia NC 28054-7414 | |
| (704) 512-3930 | |
| Not Available |
| Full Name | Eastridge Family Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1896 Remount Rd, Gastonia, North Carolina |
| Authorized Official Name and Position | Scott Rissmiller (ENTERPRISE EVP) |
| Authorized Official Contact | 7043558675 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Eastridge Family Medicine Po Box 19305 Charlotte NC 28219-9305 Ph: (704) 631-0002 | Eastridge Family Medicine 1896 Remount Rd Gastonia NC 28054-7414 Ph: (704) 512-3930 |
| NPI Number | 1477589158 |
|---|---|
| Provider Enumeration Date | 06/24/2006 |
| Last Update Date | 03/09/2023 |
| Medicare PECOS PAC ID | 2466401666 |
|---|---|
| Medicare Enrollment ID | O20050114000135 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477589158 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Everlyn Hall-baker |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1174574149 PECOS PAC ID: 5496750572 Enrollment ID: I20060923000024 |
| Provider Name | Cordula D Lutz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710111489 PECOS PAC ID: 3870759970 Enrollment ID: I20120718000000 |
| Provider Name | Amy L Randolph |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1285019000 PECOS PAC ID: 9234448069 Enrollment ID: I20151019001303 |
| Provider Name | Elizabeth Kathleen Cirullo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326489725 PECOS PAC ID: 0143458034 Enrollment ID: I20160829002134 |
| Provider Name | Jakita Charelle Strong |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124638317 PECOS PAC ID: 1456769132 Enrollment ID: I20210419000372 |
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