1497744254 NPI number — CANNON MEMORIAL HOSPITAL

Table of content: (NPI 1497744254)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497744254 NPI number — CANNON MEMORIAL HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANNON MEMORIAL HOSPITAL
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:
ANMED CANNON
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:
1497744254
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 W G ACKER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PICKENS
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29671-2739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-898-4791
Provider Business Mailing Address Fax Number:
864-899-1047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 W G ACKER DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PICKENS
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29671-2739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-878-4791
Provider Business Practice Location Address Fax Number:
864-898-1047
Provider Enumeration Date:
10/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CUNNINGHAM
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
864-512-1109

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  HTL-076 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 205007 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400113 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4200011 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 89066XH , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: CM6374 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 42-U011 . This is a "MEDICARE SWING BED UNIT" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 420011 . This is a "MEDICARE I/P & O/P" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 420011 . This is a "MEDICARE INPATIENT" identifier , issued by the state of ( SC ) . This identifiers is of the category "OTHER".
  • Identifier: 300017386A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 382878 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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