NPIMap

Organization Active NPI

Cannon Memorial Hospital

Doing business as AnMed Primary Care - Liberty

  • Rural Health Clinic/Center
  • Liberty, SC
National Provider Identifier
1902224876
Registry record updated Jun 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
CANNON MEMORIAL HOSPITAL
Doing business as
AnMed Primary Care - Liberty
Practice address
105 Liberty Blvd
Liberty, SC 29657-1641
Phone
(864) 843-9213
Fax
(864) 843-5634
NPI assigned
Mar 28, 2014
Last updated
Jun 21, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
CANNON MEMORIAL HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 21, 2023

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 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

105 Liberty Blvd
Liberty, SC 29657-1641

Mailing address

PO Box 100174
Columbia, SC 29202-3174
Phone (864) 897-8286

Other names 1

  • AnMed Primary Care - Liberty Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170420002725 SC Part A Provider - Rural Health Clinic 8123930666 Practice locations: Liberty, SC

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902224876. Details of each certification follow.

Rural health clinic certification: CCN 423462

Legal name
CANNON MEMORIAL HOSPITAL
Doing business as
ANMED PRIMARY CARE - LIBERTY
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Mar 29, 2018
Last certification
Sep 12, 2023
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Dec 27, 1950 in SC
Enrollment address
105 Liberty Blvd
Liberty, SC 29657-1641
Related CCNs
420011

Facilities connected through Provider of Services related, parent or unit certification numbers.

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 Memorial Hospital13 organizations share this tax ID, including this one
Part of
Cannon Memorial Hospital

Other organizations with this tax ID 12

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

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Linda Cassell Individual Corporate OfficerBoard Member Jan 1, 2011
Stephen J Grigsby Individual Corporate Director Apr 28, 2025
Robert Bradley Mock Individual Corporate OfficerBoard Member Jan 1, 2019
Michael Cunningham Individual Corporate OfficerBoard Member Jun 1, 2021
W-2 Managing EmployeeActing Ceo Jun 1, 2021
Harold Alexander Individual Corporate Director Feb 28, 2022
Zachary Hinton Individual Corporate OfficerBoard Member Mar 25, 2019
William Kenley Individual Corporate OfficerAnmed Health Ceo Sep 21, 2020
Corporate DirectorAnmed Health Ceo Sep 21, 2020
W-2 Managing EmployeeAnmed Ceo Sep 21, 2020
Scott Wesikittle Individual Corporate Director Aug 29, 2022
Cannon Memorial Hospital Organization, Pickens, SC Corporation 5% Or Greater Direct Ownership Interest Jan 1, 2014 100%
Operational/Managerial Control Jan 1, 2014 100%

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • 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

    • Family Medicine Physician
    • Liberty, SC
    • NPI 1750304135

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

    CMS ownership

All facility ownership & control disclosures 2

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

Owned or controlled facilities with NPI records 2

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

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

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

{
    "created_epoch": "1395964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687305600000",
    "number": "1902224876",
    "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": "864-897-8286",
            "fax_number": "864-878-0035"
        },
        {
            "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": "2014-03-28",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "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": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "AnMed Primary Care - Liberty",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Liberty, SC

Sources for this page

Verify at the official NPI Registry.