Organization
MARY BLACK HEALTH SYSTEM LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT)
(615) 465-7000
Entity
Organization
Contact information
Practice address
1690 SKYLYN DR, SUITE 300, SPARTANBURG, SC 29307-1022
(864) 582-1201
(864) 596-7409
Mailing address
PO BOX 406757, ATLANTA, GA 30384-6757
(864) 253-8063
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
207RG0100X
Gastroenterology Physician
—
—
207RI0200X
Infectious Disease Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
207Y00000X
Otolaryngology Physician
—
—
208000000X
Pediatrics Physician
—
—
2085R0202X
Diagnostic Radiology Physician
—
—
208600000X
Surgery Physician
—
—
2086S0105X
Surgery of the Hand (Surgery) Physician
—
—
208800000X
Urology Physician
—
—
208C00000X
Colon & Rectal Surgery Physician
—
—
213E00000X
Podiatrist
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CE9631
MEDICARE RAILROAD
SC
05
—
GP1325
—
SC
05
—
GP1610
—
SC
05
—
GP1628
—
SC
05
—
GP4572
—
SC
05
—
GP4573
—
SC
05
—
GP4628
—
SC
Enumeration date
06/15/2006
Last updated
07/16/2008
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