Provider Demographics
NPI:1770699514
Name:GASTON COUNTY
Entity type:Organization
Organization Name:GASTON COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:C
Authorized Official - Last Name:ASHWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-862-5404
Mailing Address - Street 1:991 W HUDSON BLVD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28052-6430
Mailing Address - Country:US
Mailing Address - Phone:704-853-5000
Mailing Address - Fax:704-862-6194
Practice Address - Street 1:991 W HUDSON BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-6430
Practice Address - Country:US
Practice Address - Phone:704-853-5000
Practice Address - Fax:704-862-6194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC34D1053826291U00000X
NC34D1053830291U00000X
NC093213336C0002X
261QP0905X, 261QP2300X, 261QC1500X, 261QF0050X, 208D00000X, 261QM2500X, 251B00000X, 251K00000X
NC34D0683590291U00000X
NC045583336C0002X
NC093223336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251K00000XAgenciesPublic Health or Welfare
No291U00000XLaboratoriesClinical Medical LaboratoryGroup - Multi-Specialty
No3336C0002XSuppliersPharmacyClinic PharmacyGroup - Multi-Specialty
No261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-Surgical
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3404444Medicaid
SCNPA740Medicaid
NC890107PMedicaid
NC0107POtherBCBS INSURANCE
NC0107POtherBCBS INSURANCE
NC890107PMedicaid