Basic Information
| Provider Information | |||||||||
| NPI: | 1073073953 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHARLES A CANNON JR MEMORIAL HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 FURMAN RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | BOONE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286075049 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8282631211 | ||||||||
| FaxNumber: | 8282624103 | ||||||||
| Practice Location | |||||||||
| Address1: | 150 PARK AVE | ||||||||
| Address2: | |||||||||
| City: | BANNER ELK | ||||||||
| State: | NC | ||||||||
| PostalCode: | 286046604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8288985178 | ||||||||
| FaxNumber: | 8282624103 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/25/2019 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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| AuthorizedOfficialLastName: | LONG | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | ETTA | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. VP MEDICAL STAFF RELATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8282624133 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.