Provider Demographics
NPI:1861416216
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:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-512-1109
Mailing Address - Street 1:PO BOX 100174
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-3174
Mailing Address - Country:US
Mailing Address - Phone:864-878-2435
Mailing Address - Fax:
Practice Address - Street 1:123 WG ACKER DR
Practice Address - Street 2:SUITE B
Practice Address - City:PICKENS
Practice Address - State:SC
Practice Address - Zip Code:29671-2739
Practice Address - Country:US
Practice Address - Phone:864-897-0390
Practice Address - Fax:864-653-7764
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANMED HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-27
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP1804Medicaid
SC5664Medicare PIN