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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
Foothills Family Medicine East Blackstock
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARY BLACK HEALTH SYSTEM, LLC
Authorized official
REBECCA HURLEY (CORPORATE PARELEGAL)
(214) 473-3993
Entity
Organization
Contact information
Practice address
245 E BLACKSTOCK RD, SPARTANBURG, SC 29301-2633
(864) 576-1614
Mailing address
PO BOX 406757, ATLANTA, GA 30384-6757
(864) 253-8063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1612
—
SC
Enumeration date
08/03/2006
Last updated
06/25/2008
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