1861645558 NPI number — CANNON MEMORIAL HOSPITAL

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861645558 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:
Provider Other Organization Name Type Code:
6
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:
1861645558
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/10/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/03/2021
NPI Reactivation Date:
09/09/2021

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDERSON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29622-1146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-878-1231
Provider Business Mailing Address Fax Number:
864-878-6656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 WG ACKER DR
Provider Second Line Business Practice Location Address:
SUITE C
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:
864-878-1231
Provider Business Practice Location Address Fax Number:
864-878-6656
Provider Enumeration Date:
10/28/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PEARSON
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
864-512-1192

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP5062 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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