NPIMap

Organization Active NPI

Black River Healthcare, Inc.

  • Family Medicine Physician
  • Olanta, SC
National Provider Identifier
1508809542
Registry record updated Apr 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BLACK RIVER HEALTHCARE, INC.
Practice address
139 Main Street
Olanta, SC 29114
Phone
(803) 433-1216
Fax
(803) 433-6796
NPI assigned
Jun 14, 2006
Last updated
Apr 8, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
BLACK RIVER HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 8, 2008

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

Authorized official

Name
Ms. Barbara Brooks
Title
Chief Executive Officer
Phone
(803) 433-1216

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X Primary
Internal Medicine Physician 207R00000X
Rural Health Clinic/Center 261QR1300X 27146 SC
Family Nurse Practitioner 363LF0000X

Addresses

Primary practice location

139 Main Street
Olanta, SC 29114

Mailing address

PO Box 578
Manning, SC 29102-0578
Phone (803) 433-1216

Other identifiers 1

IdentifierTypeStateIssuer
4400OtherSCMEDICARE PART B

Other names 1

  • BRH - Olanta Other name

National Provider Directory

National Provider Directory
Tax ID family
Black River Healthcare Inc7 organizations share this tax ID, including this one
Part of
Black River Healthcare Inc

Other organizations with this tax ID 6

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1150243200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207612800000",
    "number": "1508809542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 578",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291020578",
            "telephone_number": "803-433-1216",
            "fax_number": "803-433-6796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "139 MAIN STREET",
            "city": "OLANTA",
            "state": "SC",
            "postal_code": "29114",
            "telephone_number": "803-433-1216",
            "fax_number": "803-433-6796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLACK RIVER HEALTHCARE, INC.",
        "enumeration_date": "2006-06-14",
        "last_updated": "2008-04-08",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "803-433-1216",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": "27146",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "4400",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRH - Olanta",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Olanta, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2008; 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.