| Mary Black Health System, Llc | |
|
2995 Reidville Rd Ste 260 Spartanburg SC 29301-5667 | |
| (864) 574-2866 | |
| Not Available |
| Full Name | Mary Black Health System, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 2995 Reidville Rd Ste 260, Spartanburg, 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 138 Dillon Dr Ste A Spartanburg SC 29307-1018 Ph: (864) 542-8980 | Mary Black Health System, Llc 2995 Reidville Rd Ste 260 Spartanburg SC 29301-5667 Ph: (864) 574-2866 |
| NPI Number | 1629087754 |
|---|---|
| Provider Enumeration Date | 08/07/2006 |
| Last Update Date | 08/14/2007 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629087754 | NPI | - | NPPES |
| GP1608 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 332B00000X | Durable Medical Equipment & Medical Supplies | (* (Not Available)) | Secondary |
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