Provider Demographics
NPI:1629215298
Name:CANNON MEMORIAL HOSPITAL
Entity type:Organization
Organization Name:CANNON MEMORIAL HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-878-4791
Mailing Address - Street 1:PO BOX 919
Mailing Address - Street 2:
Mailing Address - City:PICKENS
Mailing Address - State:SC
Mailing Address - Zip Code:29671-0919
Mailing Address - Country:US
Mailing Address - Phone:864-897-8286
Mailing Address - Fax:
Practice Address - Street 1:3722 CLEMSON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1317
Practice Address - Country:US
Practice Address - Phone:864-231-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CANNON MEMORIAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty