# MARY BLACK HEALTH SYSTEM, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MARY BLACK HEALTH SYSTEM, LLC
- **Other names:** Pediatric Associates
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1588679922
- **Legal business name:** MARY BLACK HEALTH SYSTEM, LLC
- **Authorized official:** DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
- **Authorized official phone:** (615) 465-7000

## Contact information

- **Practice address:** 147 OAKWOOD AVE, SPARTANBURG, SC 29302-1207
- **Practice address phone:** (864) 582-8135
- **Mailing address:** 138 DILLON DR STE A, SPARTANBURG, SC 29307-1018
- **Mailing address phone:** (864) 542-8980
- **Mailing address fax:** (864) 515-9994

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | NULL | — |

## Other

- **Enumeration date:** 07/31/2006
- **Last updated:** 08/14/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | GP2480 | — | SC |