MEDICARE: GASTON MEMORIAL HOSPITAL, INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	282N00000X	General Acute Care Hospital	H0105	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	680HOS	OTHER		PARTNERS MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	0590625010	OTHER	CIGNA
3	371708500	OTHER	DEPARTMENT OF LABOR
4	3697	OTHER	WELLPATH
5	0067840	OTHER	AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	5040770	OTHER	UNITED HEALTHCARE
9	312280	OTHER	FEDERAL BLACKLUNG
10	00207	OTHER	BLUE CROSS

General Provider Information

NPI Number	:	1013918960
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTON MEMORIAL HOSPITAL, INCORPORATED

Provider Business Mailing Address
First Line	:	2525 COURT DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2140
Country	:	US
Telephone Number	:	704-834-2000
Fax Number	:	704-834-2500

Provider Business Practice Location Address
First Line	:	2525 COURT DR
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28054-2140
Country	:	US
Telephone Number	:	704-834-2000
Fax Number	:	704-834-2500

Authorized Official
Title or Position	:	VICE PRESIDENT / CFO
Name	:	MR. DAVID O'CONNOR
Credential	:
Telephone Number	:	704-834-2127

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	02/26/2014

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Directions to “GASTON MEMORIAL HOSPITAL, INCORPORATED ” Practice Location

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