1225088255 NPI number — CHARLES A CANNON JR MEMORIAL HOSPITAL INC.

Table of content: (NPI 1225088255)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225088255 NPI number — CHARLES A CANNON JR MEMORIAL HOSPITAL INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES A CANNON JR MEMORIAL HOSPITAL INC.
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:
APPALACHIAN REGIONAL HEALTHCARE SYSTEM
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:
1225088255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
155 FURMAN RD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BOONE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28607-5049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-262-4111
Provider Business Mailing Address Fax Number:
828-262-4157

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
434 HOSPITAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28646-0787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-262-4133
Provider Business Practice Location Address Fax Number:
828-262-4103
Provider Enumeration Date:
05/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LONG
Authorized Official First Name:
MARY
Authorized Official Middle Name:
ETTA
Authorized Official Title or Position:
SR VP MEDICAL STAFF RELATIONS
Authorized Official Telephone Number:
828-262-4133

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: H0037 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 152168200 . This is a "OWCP ACUTE CARE PROV NUMB" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0340005 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6065 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00103 . This is a "NC BLUE CROSS ACUTE CARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 5070877 . This is a "UNITED HEALTHCARE ACUTE #" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 3401323 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 290780 . This is a "MAMSI ACUTE CARE PROV NUM" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".