Provider Demographics
NPI:1013918960
Name:GASTON MEMORIAL HOSPITAL, INCORPORATED
Entity Type:Organization
Organization Name:GASTON MEMORIAL HOSPITAL, INCORPORATED
Other - Org Name:CAROMONT REGIONAL MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-834-2127
Mailing Address - Street 1:2525 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2140
Mailing Address - Country:US
Mailing Address - Phone:704-834-2000
Mailing Address - Fax:704-834-2500
Practice Address - Street 1:2525 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-834-2000
Practice Address - Fax:704-834-2500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0105282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
680HOSOtherPARTNERS MEDICARE
0590625010OtherCIGNA
371708500OtherDEPARTMENT OF LABOR
3697OtherWELLPATH
0067840OtherAETNA
NC3400032Medicaid
SC460595Medicaid
5040770OtherUNITED HEALTHCARE
312280OtherFEDERAL BLACKLUNG
00207OtherBLUE CROSS
312280OtherFEDERAL BLACKLUNG
NC235048Medicare ID - Type UnspecifiedMEDICARE PART B