Organization
MARY BLACK HEALTH SYSTEM LLC
Active
Parent organization
MARY BLACK HEALTH SYSTEM LLC
Other names
Peachview Extended Care
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
724 HYATT ST STE D, GAFFNEY, SC 29341-2630
(864) 489-5001
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
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP2924
—
SC
Enumeration date
08/18/2006
Last updated
08/14/2007
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