Provider Demographics
NPI:1912002189
Name:CHARLES A. CANNON JR. MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:CHARLES A. CANNON JR. MEMORIAL HOSPITAL
Other - Org Name:CANNON MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PATIENT FIN. SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:BARRIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-737-7011
Mailing Address - Street 1:PO BOX 459
Mailing Address - Street 2:
Mailing Address - City:LINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28646-0459
Mailing Address - Country:US
Mailing Address - Phone:828-737-7865
Mailing Address - Fax:828-737-7867
Practice Address - Street 1:436 HOSPITAL DR, SLOOP MEDICAL OFFICE PLAZA
Practice Address - Street 2:SUITE 210
Practice Address - City:LINVILLE
Practice Address - State:NC
Practice Address - Zip Code:28646
Practice Address - Country:US
Practice Address - Phone:828-737-7865
Practice Address - Fax:828-737-7867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCH0037261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132NKMedicaid
NC132NKOtherBC OF NC GRP PROV NUMBER
NC018G2OtherBC OF NC GRP PROV NUMBER
NC5902144Medicaid
NC5902144Medicaid
NC=========OtherCOMM INS GRP PROV NUMBER