Cannon Memorial Hospital
Organization Active NPI Orthopaedic Surgery Physician · Pickens, SC
NPI 1861645558 · NPPES record last updated Sep 10, 2021
Key facts
- NPI
- 1861645558
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- Legal business name
- CANNON MEMORIAL HOSPITAL
- Practice address
- 123 WG Acker Dr
Suite C
Pickens, SC 29671-2739 - Phone
- (864) 878-1231
- Fax
- (864) 878-6656
- NPI assigned
- Oct 28, 2008
- Reactivated
- Sep 9, 2021
- Organization subpart
- Yes
- Parent organization (as reported)
- CANNON MEMORIAL HOSPITAL
Authorized official
- Name
- Christine Pearson
- Title
- Ceo
- Phone
- (864) 512-1192
Other NPIs on the same Medicare enrollment 6
Practitioners 13
-
Byron Patterson Marsh, M.D.
-
James Clifton Caldwell, M.D.
-
Michael L Dillard, M.D.
-
Michael E Donald, M.D.
-
Robert Goodwin Person, M.D.
-
Thomas Richard Prostko, M.D.
-
John Randolph, M.D.
-
Glenda G. Snyder, NP
-
Peter C Woods, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040315000489 | SC | Part B Supplier - Clinic/Group Practice | 8123930666 |
Receives reassigned benefits from 21 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Clemson, SC; Easley, SC; Pickens, SC |
National Provider Directory
- Part of
- Cannon Memorial Hospital
Locations
123 Wg Acker Dr
#C
Pickens, SC 29671
Phone (864) 716-6149
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician |
207X00000X | Yes |
Addresses
Primary practice location
123 WG Acker Dr
Suite C
Pickens, SC 29671-2739
Mailing address
PO Box 1146
Anderson, SC 29622-1146
Phone (864) 878-1231
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP5062 | Medicaid | SC |
Other names
- AnMed Health Orthopaedics and Sports Medicine- Cannon
Other providers in Pickens, SC
- Cannon Memorial Hospital
- Cannon Memorial Hospital
- Cannon Memorial Hospital
- Cannon Memorial Hospital
- Cannon Memorial Hospital
- Cannon Memorial Hospital
- Ashley Denise Cantrell
- Samuel Capadano
- Carolinas Physicians Network Inc
- Carey Carrick
All providers in Pickens, SC · Orthopaedic Surgery Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.