Mary Black Health System LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MARY BLACK HEALTH SYSTEM LLC

Doing business as

Chesnee Medical Associates

Practice address

702 S Alabama Street
Chesnee, SC 29306

Phone

(864) 703-1414

NPI assigned

Jul 26, 2006

Last updated

Aug 14, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

MARY BLACK HEALTH SYSTEM 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 identifiers 1

Other names 1

• Chesnee Medical Associates Doing business as

Part of

Spartanburg Surgical CL

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187049600000",
    "number": "1720001076",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 S ALABAMA STREET",
            "city": "CHESNEE",
            "state": "SC",
            "postal_code": "29306",
            "telephone_number": "864-703-1414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "702 S ALABAMA STREET",
            "city": "CHESNEE",
            "state": "SC",
            "postal_code": "29306",
            "telephone_number": "864-703-1414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK HEALTH SYSTEM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK HEALTH SYSTEM LLC",
        "enumeration_date": "2006-07-26",
        "last_updated": "2007-08-14",
        "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": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP3769",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Chesnee Medical Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Carolyn Hendrix
• Jackie R Hill
• Laura Fisher Hodge, CCC-SLP
• Rianna Sonny Kondaveeti, D.O
• Joseph Michael Lewis, PHARM.D.
• Mary Black Physicians Group LLC
• Mary Black Physicians Group, LLC
• Mary Black Physicians Group, LLC
• Benjamin Ross McBurney, DC
• Harley Ann McClain

• Family Medicine Physician in Chesnee, SC
• Providers in Chesnee, SC by specialty
• Family Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2007; 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.