| Mary Black Health System Llc | |
|
5470 N Main St Cowpens SC 29330-9705 | |
| (864) 463-3286 | |
| Not Available |
| Full Name | Mary Black Health System Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 5470 N Main St, Cowpens, South Carolina |
| Authorized Official Name and Position | Debbie Brewer (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Contact | 6154657000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mary Black Health System Llc Po Box 406757 Atlanta GA 30384-6757 Ph: (864) 253-8080 | Mary Black Health System Llc 5470 N Main St Cowpens SC 29330-9705 Ph: (864) 463-3286 |
| NPI Number | 1326061540 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 06/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326061540 | NPI | - | NPPES |
| GP1603 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Mary Black Physicians Group, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 5470 N Main St, Cowpens, SC 29330 Phone: 864-463-3286 |