CANNON MEMORIAL HOSPITAL (NPI# 1902224876) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902224876 |
| Entity Type | Organization |
| Organization Name | CANNON MEMORIAL HOSPITAL |
| Other Organization Name | ANMED HEALTH CANNON LIBERTY FAMILY PRACTICE |
| Practice Address |
105 Liberty Blvd Liberty SC 29657-1641 |
| Mailing Address |
Po Box 919 Pickens SC 29671-0919 |
| Practice Telephone | 8648439213 |
| Practice Fax Number | 8648435634 |
| Mailing Telephone | 8648978286 |
| Mailing Fax Number | 8648780035 |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2017-02-15 |
| Authorized Official Name | BRANDON CLARY (CEO) |
| Authorized Official Telephone | 8648981133 |
| Is Organization Subpart | Y |
| Parent Organization Name | CANNON MEMORIAL HOSPITAL |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| AnMed Health Cannon Liberty Family Practice | 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 |
| 1760685143 | Cannon Memorial Hospital | Family Medicine | 111 W. Roper Rd., Easley, SC 29640 | 2007-06-06 |
| 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 |
| 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 |
105 LIBERTY BLVD |
| City | LIBERTY |
| State | SC |
| Zip Code | 29657-1641 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689677882 | John Randolph | Family Medicine | 105 Liberty Blvd, Liberty, SC 29657-1641 | 2005-05-23 |
| 1265864235 | Augusta B Hall | Nurse Practitioner | 105 Liberty Blvd, Liberty, SC 29657-1641 | 2013-08-01 |
| 1922338102 | Anmed Health | Obstetrics & Gynecology | 105 Liberty Blvd, Liberty, SC 29657-1641 | 2010-01-11 |
| 1669590477 | Travis W Davis | Family Medicine | 105 Liberty Blvd, Liberty, SC 29657-1641 | 2007-03-27 |
| 1750304135 | Cannon Memorial Hospital | Family Medicine | 105 Liberty Blvd, Liberty, SC 29657-1641 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508233206 | Healing Grace Childbirth Services, LLC | Doula | 306 Burgess Rd, Liberty, SC 29657 | 2015-08-28 |
| 1124428016 | Mustang Medicine Works, LLC | Counselor | 5642 Moorefield Memorial Hwy., Liberty, SC 29657 | 2014-08-27 |
| 1336499706 | Waiyung Florence Ho | Pharmacist | 305 W.main Street, Liberty, SC 29657 | 2012-09-13 |
| 1679822639 | Jennifer Andrews Letourneau | Pharmacist | 305 W.main St, Liberty, SC 29657 | 2012-09-06 |
| 1912256025 | Freddie Honchar | Pharmacist | 429 East Main Street, Liberty, SC 29657 | 2012-09-05 |
| 1720096704 | Emerson Wiggins Rabon Jr. | Dentist | 1074 Anderson Dr, Liberty, SC 29657 | 2006-08-04 |
| 1811476013 | Kathryn Juanita Morrow | Nurse Practitioner | 300 W Front St, Liberty, SC 29657 | 2018-08-08 |
| 1184680134 | James L Wilson | Dentist | 207 W Front St, Liberty, SC 29657-1009 | 2006-04-26 |
| 1154605624 | Bright Smile Center - Liberty, Pa | Dentist | 207 W Front St, Liberty, SC 29657-1009 | 2011-10-03 |
| 1932376035 | Liberty Dental Care, Inc. | Clinic/Center | 207 W Front St, Liberty, SC 29657-1009 | 2008-05-08 |
| Find all providers in zip 29657 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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|---|---|---|---|---|
| 1679926992 | Liberty County Hospital District No 1 | Clinic/Center | 1353 N Travis St, Liberty, TX 77575-3549 | 2016-07-21 |
| 1962759837 | Reid Physician Associates, Inc | Clinic/Center | 950 N Market St, Liberty, IN 47353-8496 | 2012-08-10 |
| 1679720114 | Casey County Hospital District | Clinic/Center | 112 Liberty Sq, Liberty, KY 42539-3392 | 2008-08-27 |
| 1164598090 | Waldo County General Hospital | Clinic/Center | 43 West Main Street, Liberty, ME 04949 | 2006-11-24 |
| 1871567362 | Casey County Hospital District | Clinic/Center | 187 Wolford Ave, Liberty, KY 42539-3187 | 2006-02-14 |
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| 1508377284 | Mcleod Physician Associates II | Clinic/Center | 1076 Marlboro Way Ste 3, Bennettsville, SC 29512-2495 | 2017-10-20 |
| 1154786960 | R Dale Padgett Md Pa | Clinic/Center | 1727 Villagepark Dr, Orangeburg, SC 29118 | 2015-12-21 |
| 1043602428 | Greenville Health System | Clinic/Center | 208 Frontage Rd Ste 1, Clemson, SC 29631-1671 | 2015-02-23 |
| 1114204153 | Mcleod Physician Associates II | Clinic/Center | 5260 Highway 9, Green Sea, SC 29545-4930 | 2011-11-04 |
| 1700160157 | Mackey Family Practice, Pa | Clinic/Center | 8351 Charlotte Hwy, Suite 200, Indian Land, SC 29707-6552 | 2011-10-04 |
| 1588943021 | Edisto Regional Health Services Inc. | Clinic/Center | 185 Mcgee St, Bamberg, SC 29003-1154 | 2011-08-16 |
| 1124307509 | Coastal Carolina Medical Center, Inc | Clinic/Center | 10911 N Jacob Smart Blvd, D, Ridgeland, SC 29936-2729 | 2011-08-16 |
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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.