Organization
BLACK RIVER HEALTHCARE, INC.
Active
Parent organization
BLACK RIVER HEALTHCARE, INC.
Other names
BRH - Kingstree
Organization subpart
Yes
Provider details
NPI number
Legal business name
BLACK RIVER HEALTHCARE, INC.
Authorized official
MS. BARBARA BROOKS (CHIEF EXECUTIVE OFFICER)
(803) 433-1216
Entity
Organization
Contact information
Practice address
520 THURGOOD MARSHALL BLVD., SUITE B, KINGSTREE, SC 29556
(843) 355-5628
(843) 355-6072
Mailing address
12 W SOUTH ST, MANNING, SC 29102-2925
(803) 433-1216
(803) 433-6796
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
208000000X
Pediatrics Physician
—
—
261QR1300X
Rural Health Clinic/Center
—
—
363L00000X
Nurse Practitioner
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4397
MEDICARE PART B
SC
Enumeration date
06/14/2006
Last updated
04/08/2008
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