Organization
MARY BLACK HEALTH SYSTEM, LLC
Active
Parent organization
MARY BLACK HEALTH SYSTEM, LLC
Other names
Glace & Norton Family Pracitice
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
2995 REIDVILLE RD STE 260, SPARTANBURG, SC 29301-5667
(864) 574-2866
Mailing address
138 DILLON DR STE A, SPARTANBURG, SC 29307-1018
(864) 542-8980
(864) 515-9994
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP1608
—
SC
Enumeration date
08/07/2006
Last updated
08/14/2007
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