Black River Healthcare, Inc.
Organization Active NPI Family Medicine Physician · Kingstree, SC
NPI 1497798599 · NPPES record last updated Apr 8, 2008
Key facts
- NPI
- 1497798599
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- BLACK RIVER HEALTHCARE, INC.
- Practice address
- 520 Thurgood Marshall Blvd.
Suite B
Kingstree, SC 29556 - Phone
- (843) 355-5628
- Fax
- (843) 355-6072
- NPI assigned
- Jun 14, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- BLACK RIVER HEALTHCARE, INC.
Authorized official
- Name
- Ms. Barbara Brooks
- Title
- Chief Executive Officer
- Phone
- (803) 433-1216
Corporate family (same tax ID) 6
National Provider Directory
- Tax ID family
- Black River Healthcare Inc
- Part of
- Black River Healthcare Inc
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes | ||
| Internal Medicine Physician |
207R00000X | |||
| Obstetrics & Gynecology Physician |
207V00000X | |||
| Pediatrics Physician |
208000000X | |||
| Rural Health Clinic/Center | 261QR1300X | |||
| Nurse Practitioner |
363L00000X | |||
| Advanced Practice Midwife |
367A00000X |
Addresses
Primary practice location
520 Thurgood Marshall Blvd.
Suite B
Kingstree, SC 29556
Mailing address
12 W South St
Manning, SC 29102-2925
Phone (803) 433-1216
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4397 | Other | SC | MEDICARE PART B |
Other names
- BRH - Kingstree
Other providers in Kingstree, SC
- Rachael Atkinson
- Bailey Transportation LLC
- Baybay'S Help
- Lathonia Bennett
- Bio-Medical Applications of South Carolina, Inc.
- Black River Healthcare, Inc.
- Black River Medical Supplies and Equipment, LLC
- Black River Pharmacy LLC
- Shannon Black
- Tonia Annette Blackwell
All providers in Kingstree, SC · Family Medicine Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 8, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.