NPIMap

Organization Active NPI

Marlboro Clinic Corp

  • Obstetrics & Gynecology Physician
  • Bennettsville, SC
National Provider Identifier
1043219637
Registry record updated Nov 9, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
Legal business name
MARLBORO CLINIC CORP
Practice address
1040 Marlboro Way
Suite 7
Bennettsville, SC 29512-2494
Phone
(843) 479-5858
Fax
(843) 454-1092
NPI assigned
Jul 18, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 9, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debbie Brewer
Title
Director
Phone
(877) 892-9813

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

1040 Marlboro Way
Suite 7
Bennettsville, SC 29512-2494

Mailing address

7100 Commerce Way
Suite 180
Brentwood, TN 37027-3280
Phone (866) 398-7108

Other identifiers 2

IdentifierTypeStateIssuer
GP3861MedicaidSC
GP4559MedicaidSC

National Provider Directory

National Provider Directory

Locations

1040 Marlboro Way
Ste 8
Bennettsville, SC 29512
Phone (843) 454-1100

Ownership & related parties

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257724800000",
    "number": "1043219637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7100 COMMERCE WAY",
            "address_2": "SUITE 180",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370273280",
            "telephone_number": "866-398-7108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 MARLBORO WAY",
            "address_2": "SUITE 7",
            "city": "BENNETTSVILLE",
            "state": "SC",
            "postal_code": "295122494",
            "telephone_number": "843-479-5858",
            "fax_number": "843-454-1092"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLBORO CLINIC CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-18",
        "last_updated": "2009-11-09",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "877-892-9813"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3861",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4559",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bennettsville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.