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Organization
MARY BLACK HEALTH SYSTEM, LLC
Active
Organization
MARY BLACK HEALTH SYSTEM, LLC
Active
Parent organization
MARY BLACK HEALTH SYSTEM, LLC
Other names
Piedmont Internal Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARY BLACK HEALTH SYSTEM, LLC
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7000
Entity
Organization
Contact information
Practice address
145B DILLON DR, SPARTANBURG, SC 29307-1017
(864) 582-7892
Mailing address
138 DILLON DR STE A, SPARTANBURG, SC 29307-1018
(864) 542-8980
(864) 515-9994
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
NULL
207R00000X
Internal Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
NULL
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
08/02/2006
Last updated
08/14/2007
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