1770699514 NPI number — GASTON COUNTY

Table of content: (NPI 1770699514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770699514 NPI number — GASTON COUNTY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTON COUNTY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GASTON COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770699514
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
991 W HUDSON BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASTONIA
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28052-6430
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-853-5000
Provider Business Mailing Address Fax Number:
704-862-6194

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
991 W HUDSON BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASTONIA
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28052-6430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-853-5000
Provider Business Practice Location Address Fax Number:
704-862-6194
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ASHWORTH
Authorized Official First Name:
CAROLYN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
PATIENT ACCOUNTS SUPERVISOR
Authorized Official Telephone Number:
704-862-5404

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QC1500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QF0050X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP0905X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 34D0683590 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 34D1053826 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 34D1053830 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 09321 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 04558 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0002X , with the licence number: 09322 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3404444 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: NPA740 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 890107P , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0107P . This is a "BCBS INSURANCE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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