NPIMap

Organization Active NPI

Mary Black Health System, LLC

  • Family Medicine Physician
  • Boiling Springs, SC
National Provider Identifier
1922013721
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
Practice address
2212 Old Furnace Rd
Boiling Springs, SC 29316-5782
Phone
(864) 578-9735
NPI assigned
Jul 30, 2006
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 President
Phone
(214) 473-3993

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Durable Medical Equipment & Medical Supplies 332B00000X
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X

Addresses

Primary practice location

2212 Old Furnace Rd
Boiling Springs, SC 29316-5782

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
GP1594MedicaidSC

Other names 1

  • Foothills Family Medicine Boiling Springs Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Mary Black Health System21 organizations share this tax ID, including this one
Part of
Mary Black Health System

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": "1154217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1922013721",
    "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": "2212 OLD FURNACE RD",
            "city": "BOILING SPRINGS",
            "state": "SC",
            "postal_code": "293165782",
            "telephone_number": "864-578-9735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK HEALTH SYSTEM, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK HEALTH SYSTEM, LLC",
        "enumeration_date": "2006-07-30",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "214-473-3993"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1594",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foothills Family Medicine Boiling Springs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boiling Springs, 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.