Mary Black Health System, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MARY BLACK HEALTH SYSTEM, LLC

Doing business as

Foothills Family Medicine East Blackstock

Practice address

245 E Blackstock Rd
Spartanburg, SC 29301-2633

Phone

(864) 576-1614

NPI assigned

Aug 3, 2006

Last updated

Jun 25, 2008By 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

Rebecca Hurley

Title

Corporate Parelegal

Phone

(214) 473-3993

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Foothills Family Medicine East Blackstock Doing business as

Part of

Spartanburg Surgical CL

Locations

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1932117389",
    "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": "245 E BLACKSTOCK RD",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293012633",
            "telephone_number": "864-576-1614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK HEALTH SYSTEM, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK HEALTH SYSTEM, LLC",
        "enumeration_date": "2006-08-03",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CORPORATE PARELEGAL",
        "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": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "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
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP1612",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Foothills Family Medicine East Blackstock",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Mary Black HLTH Sys, LLC (Carolinas Family Physicians)
• Mary Black Physician Services, LLC (Steadman Hawkins Clinic of the Carolinas)
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC (Mary Black Minor Care Center)
• Mary Black Physicians Group LLC

• Family Medicine Physician in Spartanburg, SC
• Providers in Spartanburg, 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 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.