Mary Black Physician Services, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MARY BLACK PHYSICIAN SERVICES, LLC

Practice address

1650 Skylyn Dr
Suite 200
Spartanburg, SC 29307-1047

Phone

(864) 216-4640

NPI assigned

Aug 22, 2007

Organization subpart

Yes

Parent organization

MARY BLACK PHYSICIANS SERVICES, LLCAs reported in NPPES

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

Authorized official

Name

Debbie Brewer

Title

Director of Provider Enrollment

Phone

(615) 465-7000

Specialties & licenses 1

Addresses

Other names 1

• Steadman Hawkins Clinic of the Carolinas Doing business as

Part of

Mary Black Physician Services LLC

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Mary Black Physician Services LLC

  • Nurse Practitioner
  • Duncan, SC
  • NPI 1811950645
  NPPES parent name

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

{
    "created_epoch": "1187740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1218585600000",
    "number": "1568655587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 MERIDIAN BLVD",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370676325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 SKYLYN DR",
            "address_2": "SUITE 200",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071047",
            "telephone_number": "864-216-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK PHYSICIAN SERVICES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK PHYSICIANS SERVICES, LLC",
        "enumeration_date": "2007-08-22",
        "last_updated": "2008-08-13",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR OF PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7000"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Steadman Hawkins Clinic of the Carolinas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mary Black Health System, LLC
• Mary Black Health System, LLC
• Mary Black Health System, LLC
• Mary Black Health System, LLC
• Mary Black HLTH Sys, LLC
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC

• Durable Medical Equipment & Medical Supplies in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Durable Medical Equipment & Medical Supplies in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.