Organization
MARY BLACK HEALTH SYSTEM LLC
Active
Parent organization
MARY BLACK HEALTH SYSTEM LLC
Other names
Westside Urgent Care
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARY BLACK HEALTH SYSTEM LLC
Authorized official
DEBBIE T BREWER (DIRECTOR OF PROVIDER ENROLLMETN)
(615) 465-7626
Entity
Organization
Contact information
Practice address
2995 REIDVILLE RD STE 100, SPARTANBURG, SC 29301-5600
(864) 587-3000
(864) 587-3019
Mailing address
PO BOX 406757, ATLANTA, GA 30384-6757
(864) 253-8080
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP4384
—
SC
Enumeration date
08/04/2006
Last updated
06/25/2008
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