NPIMap

Organization Active NPI

Black River Healthcare, Inc.

  • Family Medicine Physician
  • Manning, SC
National Provider Identifier
1871531574
Registry record updated Nov 18, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BLACK RIVER HEALTHCARE, INC.
Practice address
12 W South St
Manning, SC 29102-2925
Phone
(803) 433-1216
Fax
(803) 433-6796
NPI assigned
Jun 3, 2006
Last updated
Nov 18, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
BLACK RIVER HEALTHCARE, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 18, 2010

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) 433-1216

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X NU
Family Medicine Physician 207Q00000X NU Primary
Internal Medicine Physician 207R00000X NU
Pediatrics Physician 208000000X NU
Rural Health Clinic/Center 261QR1300X 16299 SC
Family Nurse Practitioner 363LF0000X NU

Addresses

Primary practice location

12 W South St
Manning, SC 29102-2925

Mailing address

12 W South St
PO Box 578
Manning, SC 29102-2925
Phone (803) 433-1216

Other identifiers 1

IdentifierTypeStateIssuer
4398OtherMEDICARE PART B

Other names 1

  • BRH - Manning Other name

National Provider Directory

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

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": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1290038400000",
    "number": "1871531574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 W SOUTH ST",
            "address_2": "PO BOX 578",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291022925",
            "telephone_number": "803-433-1216",
            "fax_number": "803-433-6796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 W SOUTH ST",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291022925",
            "telephone_number": "803-433-1216",
            "fax_number": "803-433-6796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER HEALTHCARE, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLACK RIVER HEALTHCARE, INC.",
        "enumeration_date": "2006-06-03",
        "last_updated": "2010-11-18",
        "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": "803-433-1216",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "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
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "SC",
            "license": "16299",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PART B",
            "identifier": "4398",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "BRH - Manning",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Manning, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2010; 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.