NPIMap

Organization Active NPI

SC Regional Health System LLC

Doing business as Blackville Family Medicine

  • Family Medicine Physician
  • Blackville, SC
National Provider Identifier
1467716787
Registry record updated Jul 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
SC REGIONAL HEALTH SYSTEM LLC
Doing business as
Blackville Family Medicine
Practice address
22 Gardner Rd
Blackville, SC 29817-3126
Phone
(803) 284-2041
Fax
(803) 284-5516
NPI assigned
Jul 2, 2012
Last updated
Jul 2, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2012

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

Authorized official

Name
Mary T. Valliant
Title
Ceo
Phone
(803) 541-4365

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

22 Gardner Rd
Blackville, SC 29817-3126

Mailing address

811 Reynolds Rd
Attn: Clinic Business Office
Barnwell, SC 29812-1573
Phone (803) 284-2041

Other names 1

  • Blackville Family Medicine Doing business as

National Provider Directory

National Provider Directory
Tax ID family
SC Regional Health System LLC4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

811 Reynolds Rd
Ofc
Barnwell, SC 29812

NPI Registry JSON

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

{
    "created_epoch": "1341187200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1467716787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "811 REYNOLDS RD",
            "address_2": "ATTN: CLINIC BUSINESS OFFICE",
            "city": "BARNWELL",
            "state": "SC",
            "postal_code": "298121573",
            "telephone_number": "803-284-2041",
            "fax_number": "803-284-5516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 GARDNER RD",
            "city": "BLACKVILLE",
            "state": "SC",
            "postal_code": "298173126",
            "telephone_number": "803-284-2041",
            "fax_number": "803-284-5516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SC REGIONAL HEALTH SYSTEM LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-02",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "VALLIANT",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "T.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "803-541-4365"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blackville Family Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Blackville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; 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.