NPIMap

Organization Active NPI

Mary Black Health System LLC

Doing business as Squires Pointe Medical Park

  • Family Medicine Physician
  • Duncan, SC
National Provider Identifier
1861415085
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
Squires Pointe Medical Park
Practice address
500 Squires Pointe
Duncan, SC 29334
Phone
(864) 433-8980
NPI assigned
Jul 26, 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
Debbie Brewer
Title
Director of Provider Enrollment
Phone
(615) 465-7000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

500 Squires Pointe
Duncan, SC 29334

Mailing address

PO Box 406757
Atlanta, GA 30384-6757
Phone (864) 253-8080

Other identifiers 1

IdentifierTypeStateIssuer
GP2924MedicaidSC

Other names 1

  • Squires Pointe Medical Park 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": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1861415085",
    "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": "864-253-8080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SQUIRES POINTE",
            "city": "DUNCAN",
            "state": "SC",
            "postal_code": "29334",
            "telephone_number": "864-433-8980"
        }
    ],
    "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": "2008-06-25",
        "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": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2924",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Squires Pointe Medical Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Duncan, 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.