Provider Demographics
NPI:1497744254
Name:CANNON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CANNON MEMORIAL HOSPITAL
Other - Org Name:ANMED CANNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-512-1109
Mailing Address - Street 1:123 W G ACKER DR
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-2739
Mailing Address - Country:US
Mailing Address - Phone:864-898-4791
Mailing Address - Fax:864-899-1047
Practice Address - Street 1:123 W G ACKER DR
Practice Address - Street 2:
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2739
Practice Address - Country:US
Practice Address - Phone:864-878-4791
Practice Address - Fax:864-898-1047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-14
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL-076282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC205007Medicaid
SC400113Medicaid
NC4200011Medicaid
NC89066XHMedicaid
SCCM6374OtherMEDICARE RAILROAD
SC42-U011OtherMEDICARE SWING BED UNIT
SC420011OtherMEDICARE I/P & O/P
SC420011OtherMEDICARE INPATIENT
GA300017386AMedicaid
SC382878Medicaid
NC4200011Medicaid
SC42-U011OtherMEDICARE SWING BED UNIT
SC400113Medicaid
SC382878Medicaid