MEDICARE: CAROMONT MEDICAL GROUP INC

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356520951
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROMONT MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	112 WOODLAWN RD
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-1775
Country	:	US
Telephone Number	:	704-827-3575
Fax Number	:	704-827-0840

Provider Business Practice Location Address
First Line	:	112 WOODLAWN RD
Second Line	:
City	:	MOUNT HOLLY
State	:	NC
Zip	:	28120-1775
Country	:	US
Telephone Number	:	704-827-3575
Fax Number	:	704-827-0840

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	VALINDA L RUTLEDGE
Credential	:
Telephone Number	:	704-834-2133

Provider Enumeration Date	:	10/31/2007
Last Update Date	:	06/09/2010

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Directions to “CAROMONT MEDICAL GROUP INC ” Practice Location

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