Provider Demographics
NPI:1861645558
Name:CANNON MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CANNON MEMORIAL HOSPITAL
Other - Org Name:ANMED HEALTH ORTHOPAEDICS AND SPORTS MEDICINE- CANNON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-512-1192
Mailing Address - Street 1:PO BOX 1146
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29622-1146
Mailing Address - Country:US
Mailing Address - Phone:864-878-1231
Mailing Address - Fax:864-878-6656
Practice Address - Street 1:123 WG ACKER DR
Practice Address - Street 2:SUITE C
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2739
Practice Address - Country:US
Practice Address - Phone:864-878-1231
Practice Address - Fax:864-878-6656
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANNON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2021-09-10
Deactivation Date:2021-06-03
Deactivation Code:
Reactivation Date:2021-09-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP5062Medicaid
SCGP5062Medicaid