Healthcare Provider Details

I. General information

NPI: 1902895675
Provider Name (Legal Business Name): CAROMONT HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2511 COURT DR
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

2511 COURT DR
GASTONIA NC
28054-2140
US

V. Phone/Fax

Practice location:
  • Phone: 704-671-5600
  • Fax:
Mailing address:
  • Phone: 704-671-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberAS0037
License Number StateNC

VIII. Authorized Official

Name: MR. DAVID O'CONNOR
Title or Position: VP CHIEF FINANCIAL OFFICER
Credential:
Phone: 704-834-2049