Provider Demographics
NPI:1952976003
Name:CHARLES A CANNON JR MEMORIAL HOSPITAL INC
Entity Type:Organization
Organization Name:CHARLES A CANNON JR MEMORIAL HOSPITAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SVP MEDICAL STAFF RELATIONS
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ETTA
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-262-4133
Mailing Address - Street 1:434 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:LINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28646
Mailing Address - Country:US
Mailing Address - Phone:828-262-4133
Mailing Address - Fax:828-262-4103
Practice Address - Street 1:434 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LINVILLE
Practice Address - State:NC
Practice Address - Zip Code:28646
Practice Address - Country:US
Practice Address - Phone:828-262-4133
Practice Address - Fax:828-262-4103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES A CANNON JR MEMORIAL HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty