NPIMap

Organization Active NPI

Black River Healthcare, Inc.

  • Community Health Clinic/Center
  • Kingstree, SC
National Provider Identifier
1699969733
Registry record updated Dec 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
BLACK RIVER HEALTHCARE, INC.
Practice address
500 Thurgood Marshall Boulevard
Suite a
Kingstree, SC 29556
Phone
(843) 355-1425
Fax
(843) 355-1429
NPI assigned
Aug 31, 2007
Last updated
Dec 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2008

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

Authorized official

Name
Ms. Barbara F. Brooks
Title
Chief Executive Officer
Phone
(803) 433-6790

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X 999 SC
Community Health Clinic/Center 261QC1500X Primary

Addresses

Primary practice location

500 Thurgood Marshall Boulevard
Suite a
Kingstree, SC 29556

Mailing address

PO Box 578
Manning, SC 29102-0578
Phone (843) 355-1425

Other names 1

  • Kingstree Women's Center Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699969733. Details of each certification follow.

  • CCN 421905 Federally qualified health center · Active · Name & address match · Details

Federally qualified health center certification: CCN 421905

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
KINGSTREE WOMEN'S CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
May 23, 2009
Last certification
May 23, 2009
Ownership / control type
For profit – corporation
Facility address
500 Thurgood Marshall Blvd
Kingstree, SC 29556

National Provider Directory

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

Other organizations with this tax ID 6

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

NPI Registry JSON

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

{
    "created_epoch": "1188518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228953600000",
    "number": "1699969733",
    "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": "843-355-1425",
            "fax_number": "843-355-1429"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 THURGOOD MARSHALL BOULEVARD",
            "address_2": "SUITE A",
            "city": "KINGSTREE",
            "state": "SC",
            "postal_code": "29556",
            "telephone_number": "843-355-1425",
            "fax_number": "843-355-1429"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-31",
        "last_updated": "2008-12-11",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "803-433-6790",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": "SC",
            "license": "999",
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kingstree Women's Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kingstree, SC

Sources for this page

Verify at the official NPI Registry.