Mary Black Health System LLC
Organization Active NPI Diagnostic Radiology Physician · Gaffney, SC
NPI 1609983287 · NPPES record last updated Aug 14, 2007
Key facts
- NPI
- 1609983287
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Diagnostic Radiology Physician 2085R0202X
- Legal business name
- MARY BLACK HEALTH SYSTEM LLC
- Practice address
- 724 Hyatt St Ste 2-D
Gaffney, SC 29341-2630 - Phone
- (864) 489-5001
- NPI assigned
- Aug 23, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- MARY BLACK HEALTH SYSTEM LLC
Authorized official
- Name
- Debbie Brewer
- Title
- Director of Provider Enrollment
- Phone
- (615) 465-7000
Practitioners 7
-
John R Graham, MD1
-
Ray Mills Antley Jr., M.D.
National Provider Directory
- Part of
- Mary Black Health System
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Diagnostic Radiology Physician |
2085R0202X | Yes | ||
| Durable Medical Equipment & Medical Supplies | 332B00000X |
Addresses
Primary practice location
724 Hyatt St Ste 2-D
Gaffney, SC 29341-2630
Mailing address
138 Dillon Dr Ste a
Spartanburg, SC 29307-1018
Phone (864) 542-8980
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GP2923 | Medicaid | SC |
Other names
- Peachview Radiology Center
Other providers in Gaffney, SC
- Kristin Marie Mabry
- Trisha Magnuson
- Deashia Nicole Makupson
- Laura Patterson Martin
- Mary Black Health System LLC
- Mary Black Health System LLC
- Mary Black Health System LLC
- Mary Black Health System LLC
- Mary Black Physicians Group LLC
- Mary Black Physicians Group LLC
All providers in Gaffney, SC · Diagnostic Radiology 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 Aug 14, 2007. 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.