NPIMap

Organization Active NPI

Black River Healthcare, Inc.

Doing business as Black River Healthcare - Manning Medical

  • Family Medicine Physician
  • Manning, SC
National Provider Identifier
1992077424
Registry record updated Jan 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BLACK RIVER HEALTHCARE, INC.
Doing business as
Black River Healthcare - Manning Medical
Practice address
11 W. Hospital St.
Manning, SC 29102-2925
Phone
(803) 433-4321
Fax
(803) 433-0075
NPI assigned
Jan 30, 2012
Last updated
Jan 30, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Barbara F. Brooks
Title
C.E.O.
Phone
(803) 433-6790

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

11 W. Hospital St.
Manning, SC 29102-2925

Mailing address

PO Box 578
Manning, SC 29102-0578
Phone (803) 433-6790

Other names 1

  • Black River Healthcare - Manning Medical Doing business as

National Provider Directory

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

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Locations

500 Thurgood Marshall Hwy
Ste C
Kingstree, SC 29556
Phone (843) 354-5461

520 Thurgood Marshall Hwy
#B
Kingstree, SC 29556
Phone (843) 355-5628

11 W Hospital St
Manning, SC 29102
Phone (803) 433-4124

2 Larry King Hwy
Summerton, SC 29148
Phone (803) 485-8112

206 E Market St
Timmonsville, SC 29161
Phone (803) 433-1216

206E Market St
Timmonsville, SC 29161
Phone (843) 346-3730

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1327881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327881600000",
    "number": "1992077424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 578",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291020578",
            "telephone_number": "803-433-6790",
            "fax_number": "803-433-6796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 W. HOSPITAL ST.",
            "city": "MANNING",
            "state": "SC",
            "postal_code": "291022925",
            "telephone_number": "803-433-4321",
            "fax_number": "803-433-0075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK RIVER HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-30",
        "last_updated": "2012-01-30",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "F.",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "803-433-6790"
    },
    "taxonomies": [
        {
            "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Black River Healthcare - Manning Medical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jan 30, 2012; 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.