Healthcare Provider Details

I. General information

NPI: 1013918960
Provider Name (Legal Business Name): GASTON MEMORIAL HOSPITAL, INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 02/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 COURT DR
GASTONIA NC
28054-2140
US

IV. Provider business mailing address

2525 COURT DR
GASTONIA NC
28054-2140
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2000
  • Fax: 704-834-2500
Mailing address:
  • Phone: 704-834-2000
  • Fax: 704-834-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberH0105
License Number StateNC

VIII. Authorized Official

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