NPIMap

Organization Active NPI

Charles a Cannon Jr Memorial Hospital, Inc.

Doing business as Elk River Center for Primary Care

  • Rural Health Clinic/Center
  • Banner Elk, NC
National Provider Identifier
1073073953
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CHARLES A CANNON JR MEMORIAL HOSPITAL, INC.
Doing business as
Elk River Center for Primary Care
Practice address
150 Park Ave
Banner Elk, NC 28604-6604
Phone
(828) 898-5178
Fax
(828) 262-4103
NPI assigned
Mar 25, 2019
Last updated
Jan 15, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mary Etta Long
Title
Sr. VP Medical Staff Relations
Phone
(828) 262-4133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

150 Park Ave
Banner Elk, NC 28604-6604

Mailing address

155 Furman Rd Ste 202
Boone, NC 28607-5049
Phone (828) 263-1211

Other names 1

  • Elk River Center for Primary Care Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Cobius Healthcare Solutions

National Provider Directory

National Provider Directory
Tax ID family
Sloop Cap-Avery Home Care Services14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1553472000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736899200000",
    "number": "1073073953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 FURMAN RD STE 202",
            "city": "BOONE",
            "state": "NC",
            "postal_code": "286075049",
            "telephone_number": "828-263-1211",
            "fax_number": "828-262-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 PARK AVE",
            "city": "BANNER ELK",
            "state": "NC",
            "postal_code": "286046604",
            "telephone_number": "828-898-5178",
            "fax_number": "828-262-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES A CANNON JR MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-25",
        "last_updated": "2025-01-15",
        "certification_date": "2025-01-15",
        "status": "A",
        "authorized_official_last_name": "LONG",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ETTA",
        "authorized_official_title_or_position": "SR. VP MEDICAL STAFF RELATIONS",
        "authorized_official_telephone_number": "828-262-4133"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "affiliationName": "Cobius Healthcare Solutions",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Elk River Center for Primary Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elk River Center for Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Banner Elk, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.