Basic Information
| Provider Information | |||||||||
| NPI: | 1770699514 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GASTON COUNTY | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GASTON COUNTY HEALTH DEPARTMENT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 991 W HUDSON BLVD | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280526430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048535000 | ||||||||
| FaxNumber: | 7048626194 | ||||||||
| Practice Location | |||||||||
| Address1: | 991 W HUDSON BLVD | ||||||||
| Address2: | |||||||||
| City: | GASTONIA | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280526430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048535000 | ||||||||
| FaxNumber: | 7048626194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2006 | ||||||||
| LastUpdateDate: | 08/01/2019 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ASHWORTH | ||||||||
| AuthorizedOfficialFirstName: | CAROLYN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PATIENT ACCOUNTS SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 7048625404 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 34D1053826 | NC | N | Laboratories | Clinical Medical Laboratory | 291U00000X | 34D1053830 | NC | N | Laboratories | Clinical Medical Laboratory | 3336C0002X | 09321 | NC | N | Suppliers | Pharmacy | Clinic Pharmacy | 261QP0905X | N | Ambulatory Health Care Facilities | Clinic/Center | Public Health, State or Local | 261QP2300X | N | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | 291U00000X | 34D0683590 | NC | N | Laboratories | Clinical Medical Laboratory | 3336C0002X | 04558 | NC | N | Suppliers | Pharmacy | Clinic Pharmacy | 3336C0002X | 09322 | NC | N | Suppliers | Pharmacy | Clinic Pharmacy | 261QC1500X | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 261QF0050X | N | Ambulatory Health Care Facilities | Clinic/Center | Family Planning, Non-Surgical | 208D00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice | 261QM2500X | N | Ambulatory Health Care Facilities | Clinic/Center | Medical Specialty | 251B00000X | N | Agencies | Case Management | 251K00000X | Y | Agencies | Public Health or Welfare |
ID Information
| ID | Type | State | Issuer | Description | 3404444 | 05 | NC | MEDICAID | NPA740 | 05 | SC | MEDICAID | 890107P | 05 | NC | MEDICAID | 0107P | 01 | NC | BCBS INSURANCE | OTHER |