MARY BLACK PHYSICIANS GROUP, LLC (NPI# 1104061688) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104061688 |
| Entity Type | Organization |
| Organization Name | MARY BLACK PHYSICIANS GROUP, LLC |
| Other Organization Name | MARY BLACK MINOR CARE |
| Practice Address |
2995 Reidville Rd Spartanburg SC 29301-5628 |
| Mailing Address |
Po Box 277827 Atlanta GA 30384-7827 |
| Practice Telephone | 8645873000 |
| Mailing Telephone | 8642538080 |
| Mailing Fax Number | 8645825188 |
| Enumeration Date | 2008-12-11 |
| Last Update Date | 2008-12-11 |
| Authorized Official Name | DEBBIE BREWER (DIRECTOR PROVIDER ENROLLMENT) |
| Authorized Official Telephone | 6154657626 |
| Is Organization Subpart | Y |
| Parent Organization Name | MARY BLACK PHYSICIANS GROUP, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207PE0004X |
Emergency Medicine Specialization: Emergency Medical Services |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Mary Black Minor Care | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295819415 | Mary Black Physicians Group, LLC | Clinic/Center | 500 Squire's Pointe, Duncan, SC 29334-8867 | 2006-10-24 |
| 1669554630 | Mary Black Physicians Group, LLC | Clinic/Center | 702 S Alabama Ave, Chesnee, SC 29323-1706 | 2006-10-19 |
| 1013152669 | Mary Black Physicians Group, LLC | Internal Medicine | 1690 Skylyn Dr, Suite 300, Spartanburg, SC 29307-1022 | 2008-12-11 |
| 1962647438 | Mary Black Physicians Group, LLC | Family Medicine | 1690 Skylyn Dr, Suite 210, Spartanburg, SC 29307-1022 | 2008-12-11 |
| 1598900078 | Mary Black Physicians Group, LLC | Family Medicine | 722 Hyatt St, Suite C, Gaffney, SC 29341-2643 | 2008-12-11 |
| 1487899969 | Mary Black Physicians Group, LLC | Pediatrics | 500 Squires Pt, Suite A, Duncan, SC 29334-8867 | 2008-12-11 |
| 1740425222 | Mary Black Physicians Group, LLC | Physical Medicine & Rehabilitation | 1700 Skylyn Dr, Spartanburg, SC 29307-1041 | 2008-12-11 |
| 1326283896 | Mary Black Physicians Group, LLC | Internal Medicine | 2995 Reidville Rd, Suite 210, Spartanburg, SC 29301-5628 | 2008-12-11 |
| 1053556522 | Mary Black Physicians Group, LLC | Family Medicine | 1250 John B White Sr Blvd, Spartanburg, SC 29306-3929 | 2008-12-11 |
| 1295970770 | Mary Black Physicians Group, LLC | Surgery | 1690 Skylyn Dr, Suite 140, Spartanburg, SC 29307-1022 | 2008-12-11 |
| Street Address |
2995 REIDVILLE RD |
| City | SPARTANBURG |
| State | SC |
| Zip Code | 29301-5628 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881659712 | Royal Albert Hobbs | Plastic Surgery | 2995 Reidville Rd, Suite 150, Spartanburg, SC 29301-5668 | 2006-04-20 |
| 1619339660 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 2995 Reidville Rd, Spartanburg, SC 29301-5628 | 2016-03-28 |
| 1861817819 | Lettie Jane Haynes | Nurse Practitioner | 2995 Reidville Rd, Spartanburg, SC 29301-5628 | 2014-02-27 |
| 1619310844 | Precision Plastic Surgery Pa | Plastic Surgery | 2995 Reidville Rd, Suite 150, Spartanburg, SC 29301-5668 | 2013-04-08 |
| 1578806618 | Jessica L Heintzelman | Family Medicine | 2995 Reidville Rd, Suite 210, Spartanburg, SC 29301-5628 | 2013-03-27 |
| 1326283896 | Mary Black Physicians Group, LLC | Internal Medicine | 2995 Reidville Rd, Suite 210, Spartanburg, SC 29301-5628 | 2008-12-11 |
| 1306081880 | Mary Black Physicians Group, LLC | Family Medicine | 2995 Reidville Rd, Suite 260, Spartanburg, SC 29301-5628 | 2008-12-11 |
| 1053556191 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 2995 Reidville Rd, Spartanburg, SC 29301-5628 | 2008-12-03 |
| 1518112143 | Spartanburg Medical Center | Obstetrics & Gynecology | 2995 Reidville Rd, Suite 290, Spartanburg, SC 29301-5628 | 2008-11-24 |
| 1053511766 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 2995 Reidville Rd, Ste 290, Spartanburg, SC 29301-5628 | 2007-07-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033716253 | Proactive Md Tindall Spartanburg Health Center | Family Medicine | 2273 Hayne St., Spartanburg, SC 29301 | 2020-10-01 |
| 1841757192 | Paladina Health, LLC | Family Medicine | Paladina Health Smith Drug, 9098 Fairforest Road, Spartanburg, SC 29301 | 2019-02-22 |
| 1073021143 | Yamira Valentin-fuentes | Chiropractor | 210 Westgate Mall Dr, Suite 6, Spartanburg, SC 29301 | 2018-01-11 |
| 1124426382 | Shellie Smith | Social Worker | 101 Washington Place, Spartanburg, SC 29301 | 2014-12-19 |
| 1356751770 | Lindsey Marie Dillon | Counselor | 250 Dewey Ave., Spartanburg, SC 29301 | 2014-05-07 |
| 1568892461 | Lauren Campbell Heiser | Physical Therapist | 2660 Reidville Rd # 6&7, Spartanburg, SC 29301 | 2013-11-14 |
| 1871843227 | Amy L Roberts | Occupational Therapist | 355 Oak Grove Rd., Spartanburg, SC 29301 | 2012-09-13 |
| 1023384419 | Elizabeth B. Gurley | Pharmacist | 211 West Blackstock Rd, Spartanburg, SC 29301 | 2012-03-29 |
| 1649564063 | Brooke Webster Fuentes | Physician Assistant | 300 E Blackstock Road, Suite E, Spartanburg, SC 29301 | 2011-06-02 |
| 1487943023 | Margaret Elizabeth Wilson | Counselor | 100 Ezell St., Spartanburg, SC 29301 | 2011-04-05 |
| Find all providers in zip 29301 | ||||
| Taxonomy Code | 207PE0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Emergency Medicine |
| Specialization | Emergency Medical Services |
| An emergency medicine physician who specializes in non-hospital based emergency medical services (e.g., disaster site, accident scene, transport vehicle, etc.) to provide pre-hospital assessment, treatment, and transport patients. |
| Notes: Source: National Uniform Claim Committee, 2009 [1/1/2010: definition added, source added] Additional Resources: A Certification of Added Qualifications (CAQ) is issued by the American Osteopathic Board of Emergency Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376648667 | Cathy Ann Messer | Emergency Medicine | 101 E. Wood Street, Spartanburg, SC 29303 | 2006-09-13 |
| 1265457691 | Deepak Malhan | Emergency Medicine | 2995 Reidville Rd Ste 100, Spartanburg, SC 29301-5600 | 2006-07-13 |
| 1952372823 | Frank Joe Singletary | Emergency Medicine | 101 E Wood St, Spartanburg, SC 29303-3040 | 2006-01-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164999744 | Joseph Simmons Jr. | Emergency Medicine | 3300 W Brewington Rd, Sumter, SC 29153-8336 | 2018-10-31 |
| 1053720417 | Ralph Mckeetha Shealy | Emergency Medicine | 2719 Coddell Ct, Mount Pleasant, SC 29466-7930 | 2014-08-10 |
| 1508158296 | Toni Nmi Manos | Emergency Medicine | 1742 E. Ashley Ave., Folly Beach, SC 29439-0049 | 2011-05-12 |
| 1104096619 | Steve W. Schwartz | Emergency Medicine | 671 Jamestown Dr Ste 203, Murrells Inlet, SC 29576-7507 | 2008-03-11 |
| 1629294798 | Clara Elisabeth Gulyas | Emergency Medicine | 202 Wall St, Piedmont, SC 29673-6754 | 2007-04-17 |
| 1598897951 | Stephen A Harvey | Emergency Medicine | 3655 Mitchell St # 690001, Loris, SC 29569-2827 | 2007-03-12 |
| 1285776674 | Cox Medical Response Inc | Emergency Medicine | 312 S Pine St, Marion, SC 29571 | 2007-02-13 |
| 1285706747 | Malcolm Keith Sale | Emergency Medicine | 20 Balmoral Pl, Hilton Head Island, SC 29926-2270 | 2006-11-13 |
| 1629169867 | James D Dunda | Emergency Medicine | 1011 Ella St, Anderson, SC 29621-4807 | 2006-09-27 |
| 1518068873 | Marva Denise Williams | Emergency Medicine | 107 Sunset Dr, Manning, SC 29102-2904 | 2006-09-26 |
| Find all providers with the same taxonomy | ||||
| City | SPARTANBURG |
| Zip Code | 29301 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.