CANNON MEMORIAL HOSPITAL (NPI# 1760685143) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760685143 |
| Entity Type | Organization |
| Organization Name | CANNON MEMORIAL HOSPITAL |
| Other Organization Name | CANNON FAMILY PRACTICE - EASTSIDE |
| Practice Address |
111 W. Roper Rd. Easley SC 29640 |
| Mailing Address |
Po Box 919 Pickens SC 29671-0919 |
| Practice Telephone | 8648978280 |
| Practice Fax Number | 8648978281 |
| Mailing Telephone | 8648978286 |
| Mailing Fax Number | 8648978281 |
| Enumeration Date | 2007-06-06 |
| Last Update Date | 2010-07-20 |
| Authorized Official Name | MR. NORMAN GENE RENTZ (CEO) |
| Authorized Official Telephone | 8648784791 |
| Is Organization Subpart | Y |
| Parent Organization Name | CANNON MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP4650 | 05 |
| Other Name | Type Code |
|---|---|
| Cannon Family Practice - Eastside | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629215298 | Cannon Memorial Hospital | Orthopaedic Surgery | 3722 Clemson Blvd, Suite A, Anderson, SC 29621-1317 | 2009-01-19 |
| 1457427494 | Cannon Memorial Hospital | Surgery | 123 Wg Acker Dr Ste D, Pickens, SC 29671-2739 | 2006-11-28 |
| 1497744254 | Cannon Memorial Hospital | General Acute Care Hospital | 123 W G Acker Dr, Pickens, SC 29671-2739 | 2005-10-14 |
| 1295267227 | Cannon Memorial Hospital | Otolaryngology | 885 Tiger Blvd Ste A, Clemson, SC 29631-1480 | 2017-03-29 |
| 1902224876 | Cannon Memorial Hospital | Clinic/Center | 105 Liberty Blvd, Liberty, SC 29657-1641 | 2014-03-28 |
| 1861645558 | Cannon Memorial Hospital | Orthopaedic Surgery | 123 Wg Acker Dr, Suite C, Pickens, SC 29671-2739 | 2008-10-28 |
| 1497910772 | Cannon Memorial Hospital | Family Medicine | 865 Pendleton St, Pickens, SC 29671-2578 | 2008-07-25 |
| 1679738199 | Cannon Memorial Hospital | Orthopaedic Surgery | 115 Brushy Creek Rd, Easley, SC 29642-1120 | 2008-07-24 |
| 1700890084 | Cannon Memorial Hospital | Family Medicine | 111 W Roper Rd, Easley, SC 29640-8805 | 2006-07-29 |
| 1861416216 | Cannon Memorial Hospital | Family Medicine | 123 Wg Acker Dr, Suite B, Pickens, SC 29671-2739 | 2006-07-27 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | CANNON MEMORIAL HOSPITAL | 434 Hospital Dr, Linville, NC 28646 |
| Street Address |
111 W. ROPER RD. |
| City | EASLEY |
| State | SC |
| Zip Code | 29640 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063935773 | Mary Kathryn Henderson | Speech-Language Pathologist | 1400 Griffin Mill Road, Easley, SC 29640 | 2017-07-25 |
| 1417309451 | Ashby Park Pediatric Dentistry Easley | Dentist | 708 North A Street, Easley, SC 29640 | 2016-07-01 |
| 1548696990 | Phuong T Tran | Pharmacist | 309 Rolling Hills Circle, Easley, SC 29640 | 2013-09-17 |
| 1538593017 | Baptist Easley Hospital | Clinic/Center | 200 Fleet Wood Dr 3 Rd Floor, Easley, SC 29640 | 2013-09-03 |
| 1942507173 | Joanne Mason Wilkinson | Occupational Therapist | 1807a East Main St, Easley, SC 29640 | 2011-02-24 |
| 1861793911 | Ark Pharmacy Services LLC | Pharmacy | 5119- A Calhoun Memorial Hwy, Easley, SC 29640 | 2010-11-05 |
| 1659507952 | Sarah Elizabeth Proulx | Dentist | 227 South Pendleton Street, Suita A, Easley, SC 29640 | 2009-06-02 |
| 1508030503 | Jean Claire Palmour | Massage Therapist | 404 South Fifth Street, Jj & Company Salon & Spa, Easley, SC 29640 | 2008-04-22 |
| 1942419171 | William Kent Hammond | Dentist | 298 Enterprise Dr, Easley, SC 29640 | 2007-05-22 |
| 1265645352 | Palmetto Health | Family Medicine | 104 Fleetwood Drive, Easley, SC 29640 | 2007-05-07 |
| Find all providers in zip 29640 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770787426 | Myra Aurelia Phipps | Family Medicine | 303 Dacusville Hwy, Easley, SC 29640-1510 | 2007-06-14 |
| 1265645352 | Palmetto Health | Family Medicine | 104 Fleetwood Drive, Easley, SC 29640 | 2007-05-07 |
| 1821018391 | Anne-marie Catherine Leventis | Family Medicine | 202 Buckingham Rd, Easley, SC 29640-1358 | 2006-07-20 |
| 1609895523 | Marian Barton Clinch | Family Medicine | 300 Fleetwood Drive, Easley, SC 29640 | 2006-07-19 |
| 1235174848 | Palmetto Health | Family Medicine | 201 W A Ave, Easley, SC 29640-2051 | 2006-06-18 |
| 1790737369 | Palmetto Health | Family Medicine | 106 John St, Suite B, Easley, SC 29640-1415 | 2006-05-16 |
| 1811948896 | Palmetto Health | Family Medicine | 104 Fleetwood Dr, Easley, SC 29640-2020 | 2006-05-13 |
| 1033173778 | Patrick G Lollis | Family Medicine | 700 Brushy Creek Rd, Easley, SC 29642-2200 | 2006-04-12 |
| 1558364109 | Ben William Wilson Jr. | Family Medicine | 10701 Anderson Rd, Easley, SC 29642-9309 | 2005-05-27 |
| 1154859031 | Baptist Easley | Family Medicine | 200 Fleetwood Dr, Easley, SC 29640-2022 | 2017-05-23 |
| Find all providers in EASLEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.