Provider Demographics
NPI:1932258506
Name:GASTON COUNTY
Entity Type:Organization
Organization Name:GASTON COUNTY
Other - Org Name:GASTON CO MED TRANSPORT
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMPHIEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-866-3202
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28053-1475
Mailing Address - Country:US
Mailing Address - Phone:704-866-3202
Mailing Address - Fax:704-866-3203
Practice Address - Street 1:615 N HIGHLAND ST
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-2179
Practice Address - Country:US
Practice Address - Phone:704-866-3271
Practice Address - Fax:704-866-3203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC03606833416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC07230OtherBCBS ID NUMBER
NC3406817Medicaid
NC278041Medicare ID - Type UnspecifiedMEDICARE ID NUMBER