NPIMap

Organization Active NPI

Mary Black Health System, LLC

Doing business as Family Physicains of Spartanburg

  • Family Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1710094388
Registry record updated Jun 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARY BLACK HEALTH SYSTEM, LLC
Doing business as
Family Physicains of Spartanburg
Practice address
1250 John B White Sr Blvd
Spartanburg, SC 29306-3929
Phone
(864) 576-9201
Fax
(864) 576-6584
NPI assigned
Aug 23, 2006
Last updated
Jun 25, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY BLACK HEALTH SYSTEM, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 25, 2008

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

Authorized official

Name
Rebecca Hurley
Title
Senior Vice Presidetn
Phone
(214) 473-3993

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X NU
Family Nurse Practitioner 363LF0000X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU

Addresses

Primary practice location

1250 John B White Sr Blvd
Spartanburg, SC 29306-3929

Mailing address

PO Box 406757
Atlanta, GA 30384-6757
Phone (864) 253-8063

Other identifiers 1

IdentifierTypeStateIssuer
GP1771MedicaidSC

Other names 1

  • Family Physicains of Spartanburg Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Spartanburg Surgical CL21 organizations share this tax ID, including this one
Part of
Spartanburg Surgical CL

Other organizations with this tax ID 20

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

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1156291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1710094388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 406757",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303846757",
            "telephone_number": "864-253-8063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1250 JOHN B WHITE SR BLVD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293063929",
            "telephone_number": "864-576-9201",
            "fax_number": "864-576-6584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK HEALTH SYSTEM, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK HEALTH SYSTEM, LLC",
        "enumeration_date": "2006-08-23",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDETN",
        "authorized_official_telephone_number": "214-473-3993"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1771",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Physicains of Spartanburg",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.