Provider Demographics
NPI:1790066876
Name:CAROMONT HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CAROMONT HEALTH SERVICES, INC.
Other - Org Name:CAROMONT ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACTING CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUCKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-834-3684
Mailing Address - Street 1:PO BOX 1747
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-1747
Mailing Address - Country:US
Mailing Address - Phone:704-834-2155
Mailing Address - Fax:704-834-2138
Practice Address - Street 1:1212 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-3385
Practice Address - Country:US
Practice Address - Phone:704-825-5677
Practice Address - Fax:704-825-1197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-02
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical