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Organization
MARY BLACK HEALTH SYSTEM LLC
Active
Organization
MARY BLACK HEALTH SYSTEM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7000
Entity
Organization
Contact information
Practice address
1690 SKYLYN DR, SUITE 300, SPARTANBURG, SC 29307-1022
(864) 582-1201
(864) 596-7409
Mailing address
PO BOX 406757, ATLANTA, GA 30384-6757
(864) 253-8063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
208800000X
Urology Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
213E00000X
Podiatrist
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE9631
MEDICARE RAILROAD
SC
05
—
GP1325
—
SC
05
—
GP1610
—
SC
05
—
GP1628
—
SC
05
—
GP4572
—
SC
05
—
GP4573
—
SC
05
—
GP4628
—
SC
Enumeration date
06/15/2006
Last updated
07/16/2008
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