NPIMap

Organization Active NPI

Cannon Memorial Hospital

Doing business as AnMed Primary Care-Liberty

  • Family Medicine Physician
  • Liberty, SC
National Provider Identifier
1750304135
Registry record updated Jan 23, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
CANNON MEMORIAL HOSPITAL
Doing business as
AnMed Primary Care-Liberty
Cannon Family Practice - Liberty
Practice address
105 Liberty Blvd
Liberty, SC 29657-1641
Phone
(864) 843-9213
Fax
(864) 843-5634
NPI assigned
Jul 26, 2006
Last updated
Jan 23, 2025By the provider in NPPES
Organization subpart
Yes
Parent organization
CANNON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 23, 2025

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

Authorized official

Name
Michael Cunningham
Title
Ceo
Phone
(864) 898-1133

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary

Addresses

Primary practice location

105 Liberty Blvd
Liberty, SC 29657-1641

Mailing address

PO Box 100174
Columbia, SC 29202-3174
Phone (864) 897-8280

Other identifiers 1

IdentifierTypeStateIssuer
GP2510MedicaidSC

Other names 2

  • AnMed Primary Care-Liberty Doing business as
  • CANNON FAMILY PRACTICE - LIBERTY Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031103000506 SC Part B Supplier - Clinic/Group Practice 8123930666 Receives reassigned benefits from 11 practitioners
Practice locations: Liberty, SC

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Cannon Mem Hosp13 organizations share this tax ID, including this one
Part of
Cannon Mem Hosp

Other organizations with this tax ID 12

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

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

895 Tiger Blvd
Ste A
Clemson, SC 29631

Ownership & related parties

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Anmed CannonPickens, SC, CCN 420011 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2014
Jan 1, 2014
Anmed Primary Care - EasleyEasley, SC, CCN 423457 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2014
Jan 1, 2014
Anmed Primary Care - LibertyLiberty, SC, CCN 423462 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jan 1, 2014
Jan 1, 2014

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Cannon Memorial Hospital

    dba AnMed Cannon

    • General Acute Care Hospital
    • Pickens, SC
    • NPI 1497744254

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Cannon Memorial Hospital

    dba AnMed Primary Care - Easley

    • Rural Health Clinic/Center
    • Easley, SC
    • NPI 1700890084

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership
  • Cannon Memorial Hospital

    dba AnMed Primary Care - Liberty

    • Rural Health Clinic/Center
    • Liberty, SC
    • NPI 1902224876

    5% Or Greater Direct Ownership Interest, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1737590400000",
    "number": "1750304135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100174",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292023174",
            "telephone_number": "864-897-8280",
            "fax_number": "864-897-8281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 LIBERTY BLVD",
            "city": "LIBERTY",
            "state": "SC",
            "postal_code": "296571641",
            "telephone_number": "864-843-9213",
            "fax_number": "864-843-5634"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CANNON MEMORIAL HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "CANNON MEMORIAL HOSPITAL",
        "enumeration_date": "2006-07-26",
        "last_updated": "2025-01-23",
        "certification_date": "2025-01-23",
        "status": "A",
        "authorized_official_last_name": "CUNNINGHAM",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "864-898-1133"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2510",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AnMed Primary Care-Liberty",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CANNON FAMILY PRACTICE - LIBERTY",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "CANNON FAMILY PRACTICE - LIBERTY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty, SC

Sources for this page

Verify at the official NPI Registry.