CAROMONT MEDICAL GROUP INC (NPI# 1568641165) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1568641165 |
| Entity Type | Organization |
| Organization Name | CAROMONT MEDICAL GROUP INC |
| Other Organization Name | CAROMONT FAMILY MEDICINE |
| Practice Address |
1200 Village Harbor Dr Lake Wylie SC 29710-9092 |
| Practice Telephone | 8036312858 |
| Practice Fax Number | 8036312862 |
| Mailing Telephone | 8036312858 |
| Mailing Fax Number | 8036312862 |
| Enumeration Date | 2007-10-31 |
| Last Update Date | 2010-06-09 |
| Authorized Official Name | VALINDA L RUTLEDGE (PRESIDENT, CEO) |
| Authorized Official Telephone | 7048342133 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NC | 890267Q | 05 |
| Other Name | Type Code |
|---|---|
| CaroMont Family Medicine | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457913006 | Caromont Medical Group Inc | Podiatrist | 2555 Court Dr Ste 250, Gastonia, NC 28054-2185 | 2019-07-03 |
| 1710359757 | Caromont Medical Group Inc | Anesthesiology | 1212 Spruce Street, Suite 305a, Belmont, NC 28012-3386 | 2015-10-29 |
| 1285940445 | Caromont Medical Group Inc | Family Medicine | 3845 S. New Hope Rd, Gastonia, NC 28056-8439 | 2010-08-26 |
| 1205079290 | Caromont Medical Group Inc | Family Medicine | 305 W. College Ave, Boiling Springs, NC 28017-0815 | 2009-04-07 |
| 1124207725 | Caromont Medical Group Inc | Family Medicine | 120 S Mountain St, Cherryville, NC 28021-3421 | 2007-10-31 |
| 1982883583 | Caromont Medical Group Inc | Family Medicine | 1895 Hoffman Road, Suite A, Gastonia, NC 28054-6557 | 2007-10-31 |
| 1952580557 | Caromont Medical Group Inc | Family Medicine | 4235 S. New Hope Road, Suite A, Gastonia, NC 28056-8453 | 2007-10-31 |
| 1407035025 | Caromont Medical Group Inc | Family Medicine | 14035 Grandiflora Drive, Ste B, Charlotte, NC 28278-8456 | 2007-10-31 |
| 1437338050 | Caromont Medical Group Inc | Obstetrics & Gynecology | 620 Summit Crossing Pl Ste 108c, Gastonia, NC 28054-2189 | 2007-10-31 |
| 1083069017 | Caromont Medical Group Inc | Internal Medicine | 2544 Court Dr, Suite D, Gastonia, NC 28054-3450 | 2016-04-27 |
| Street Address |
1200 VILLAGE HARBOR DR |
| City | LAKE WYLIE |
| State | SC |
| Zip Code | 29710-9092 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164504429 | Kristen Jean Burns | Nurse Practitioner | 1200 Village Harbor Dr, Lake Wylie, SC 29710-9092 | 2006-10-19 |
| 1770970873 | Amanda C Ivey | Nurse Practitioner | 1200 Village Harbor Dr, Lake Wylie, SC 29710-9092 | 2015-04-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346728243 | Jessica Pampalone | Pharmacist | 175 Sc-274, Lake Wylie, SC 29710 | 2018-08-02 |
| 1932628344 | Andrew Thomas Sullivan | Student in an Organized Health Care Education/Training Program | 106 Mccall Street, Clover, SC 29710 | 2017-09-18 |
| 1619423449 | Dental Professionals of South Carolina, P.C. | Dentist | 209 Latitude Lane, Clover, SC 29710 | 2016-08-31 |
| 1932538816 | Tara Mehta | Psychologist | 48 Fairway Rdg, Clover, SC 29710 | 2013-11-01 |
| 1710238795 | Hong N Mitchell | Pharmacist | 158 Hwy. 274, Lake Wylie, SC 29710 | 2012-10-01 |
| 1790948602 | Barbara Ellen Anslow-myers | Speech-Language Pathologist | 530 Little Cove Lane, Lake Wylie, SC 29710 | 2008-07-10 |
| 1720200884 | Lake Wylie | Assisted Living Facility | 4877 Charlotte Highway, Lake Wylie, SC 29710 | 2007-05-02 |
| 1790804581 | Phillip Russell Sanford | Pharmacist | 3272 Wicklow Ln, Clover, SC 29710 | 2007-03-29 |
| 1124158472 | Thomas N Stall Sr. | Dentist | 1100 Village Harbor Dr., Lake Wylie, SC 29710 | 2007-03-06 |
| 1043369457 | John Frank Ruocco | Dentist | 140 Highway 274, Clover, SC 29710 | 2007-01-09 |
| Find all providers in zip 29710 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
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| 1063024578 | Beaufort County Memorial Hospital | Family Medicine | Beaufort Memorial Preoperative Assessment Clinic, 989 Ribaut Road Suite 370, Beaufort, SC 29902 | 2020-08-18 |
| 1841801149 | Palmetto Primary Care Physicians, LLC | Family Medicine | 1200 Two Island Ct Unit E, Mt Pleasant, SC 29466-7418 | 2020-08-11 |
| 1922617950 | Fred E Hill | Family Medicine | 1033 Jervey Point Rd, Charleston, SC 29492-8372 | 2020-07-27 |
| Find all providers with the same taxonomy | ||||
| City | LAKE WYLIE |
| Zip Code | 29710 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.