Organization
MARY BLACK HEALTH SYSTEM, LLC
Active
Parent organization
MARY BLACK HEALTH SYSTEM, LLC
Other names
Bass Urology
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
1 DOCTORS PARK DR, SPARTANBURG, SC 29307-1021
(864) 585-2587
(864) 585-2141
Mailing address
138 DILLON DR STE A, SPARTANBURG, SC 29307-1018
(864) 542-8980
(864) 515-9994
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP3679
—
SC
Enumeration date
08/03/2006
Last updated
08/14/2007
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