Provider Demographics
NPI:1902895675
Name:CAROMONT HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CAROMONT HEALTH SERVICES, INC.
Other - Org Name:CAROMONT SPECIALTY SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-834-2049
Mailing Address - Street 1:2511 COURT DR
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2140
Mailing Address - Country:US
Mailing Address - Phone:704-671-5600
Mailing Address - Fax:
Practice Address - Street 1:2511 COURT DR
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2140
Practice Address - Country:US
Practice Address - Phone:704-671-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-17
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCAS0037261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0734076003OtherCIGNA
NC00632OtherBLUE CROSS
NC0585105OtherAETNA
NC371708500OtherDEPARTMENT OF LABOR
NC5040770OtherUNITED HEALTHCARE
SCASC002Medicaid
NC3409852Medicaid
NC3697OtherWELLPATH
NC312280OtherFEDERAL BLACK LUNG
NC0585105OtherAETNA
SCASC002Medicaid
NC0734076003OtherCIGNA