NPIMap

Organization Active NPI

Charles a. Cannon, Jr. Memorial Hospital, Inc.

Doing business as Outpatient Laboratory

  • Clinical Medical Laboratory
  • Linville, NC
National Provider Identifier
1437541984
Registry record updated Jan 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
H0077 Issued in NC
Legal business name
CHARLES A. CANNON, JR. MEMORIAL HOSPITAL, INC.
Doing business as
Outpatient Laboratory
Practice address
434 Hospital Drive
Linville, NC 28646-0787
Phone
(828) 737-7000
Fax
(828) 262-4103
NPI assigned
Feb 20, 2015
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
Ms. Mary Etta Long
Title
Sr VP Medical Staff Relations
Phone
(828) 262-4133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X H0077 NC Primary

Addresses

Primary practice location

434 Hospital Drive
Linville, NC 28646-0787

Mailing address

434 Hospital Drive
Linville, NC 28646-0787
Phone (828) 737-7000

Other names 1

  • Outpatient Laboratory 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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0655475Charles a Cannon Jr Mem Hospital Lab434 Hospital Drive, Linville, NC 28646AccreditationNov 30, 2027

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": "1424390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736899200000",
    "number": "1437541984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 HOSPITAL DRIVE",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "286460787",
            "telephone_number": "828-737-7000",
            "fax_number": "828-262-4103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "434 HOSPITAL DRIVE",
            "city": "LINVILLE",
            "state": "NC",
            "postal_code": "286460787",
            "telephone_number": "828-737-7000",
            "fax_number": "828-262-4103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES A. CANNON, JR. MEMORIAL HOSPITAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-20",
        "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",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NC",
            "license": "H0077",
            "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": "Outpatient Laboratory",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Linville, 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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.