MARY BLACK PHYSICIANS GROUP, LLC (NPI# 1295970770) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1295970770 |
| Entity Type | Organization |
| Organization Name | MARY BLACK PHYSICIANS GROUP, LLC |
| Other Organization Name | MARY BLACK SURGERY ASSOCIATES |
| Practice Address |
1690 Skylyn Dr Suite 140 Spartanburg SC 29307-1022 |
| Mailing Address |
Po Box 277827 Atlanta GA 30384-7827 |
| Practice Telephone | 8645911664 |
| 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 | 208600000X | Surgery | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Mary Black Surgery Associates | 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 |
| 1104061688 | Mary Black Physicians Group, LLC | Emergency Medicine | 2995 Reidville Rd, Spartanburg, SC 29301-5628 | 2008-12-11 |
| Street Address |
1690 SKYLYN DR SUITE 140 |
| City | SPARTANBURG |
| State | SC |
| Zip Code | 29307-1022 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356338156 | Frederick C. Swensen | Plastic Surgery | 1690 Skylyn Dr, Suite 100, Spartanburg, SC 29307-1022 | 2005-10-05 |
| 1659775617 | Roxanne Singer-gheorghiu | Nurse Practitioner | 1690 Skylyn Dr, Suite 140, Spartanburg, SC 29307-1022 | 2014-10-20 |
| 1518366483 | Bg Neurology LLC | Clinic/Center | 1690 Skylyn Dr, Suite 140, Spartanburg, SC 29307-1022 | 2014-08-17 |
| 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 |
| 1992925713 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 1690 Skylyn Dr, Suite 210, Spartanburg, SC 29307-1022 | 2007-04-26 |
| 1821216953 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 1690 Skylyn Dr, Suite 300, Spartanburg, SC 29307-1022 | 2007-04-23 |
| 1578507174 | Mary Black Health System LLC | Internal Medicine | 1690 Skylyn Dr, Suite 300, Spartanburg, SC 29307-1022 | 2006-06-15 |
| 1578510491 | John Thompson Tate | Surgery | 1690 Skylyn Dr, Suite 140, Spartanburg, SC 29307-1022 | 2006-05-27 |
| 1588617310 | Max Cortez Finch Jr. | Internal Medicine | 1690 Skylyn Dr, Suite 300, Spartanburg, SC 29307-1022 | 2006-05-19 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023677945 | Healogics Specialty Physicians of South Carolina, LLC | Clinic/Center | 1630 Skylyn Drive, Suite 420, Spartanburg, SC 29307 | 2019-06-13 |
| 1194247528 | Tawnia Lee Prince | Occupational Therapy Assistant | 110 Summit Knoll Drive, Spartanburg, SC 29307 | 2017-07-07 |
| 1730633553 | Laura K Taylor | Chiropractor | 1802 Drayton Road, Suite 309, Spartanburg, SC 29307 | 2016-08-10 |
| 1013372390 | Erin Lavette Farr | Nurse Practitioner | 2780 East Main Street, Ltc Health Solutions, Spartanburg, SC 29307 | 2015-12-30 |
| 1316312010 | Joy Rogers | Speech-Language Pathologist | 175 Burdette St, Spartanburg, SC 29307 | 2015-12-07 |
| 1376923169 | Olivia Conrad | Speech-Language Pathologist | 220 Sloans Grove Rd, Spartanburg, SC 29307 | 2015-06-05 |
| 1457755118 | Optimal Radiology Partners of Virginia, Pllc | Radiology | 75 Skylyn Drive, Spartanburg, SC 29307 | 2014-10-09 |
| 1295033272 | Sean Quinn | Pharmacist | 790 East Main Street, Spartanburg, SC 29307 | 2011-03-01 |
| 1417250887 | James Edward Bradof | Internal Medicine | 212 Cypress Creek Drive, Spartanburg, SC 29307 | 2010-12-07 |
| 1528388030 | Tanya Tocharoen Tang | Internal Medicine | 126 Dillon Dr., Spartanburg, SC 29307 | 2010-06-07 |
| Find all providers in zip 29307 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073136511 | Trey Jeffrey Mathews | Surgery | 101 E. Wood St, Spartanburg, SC 29303-3098 | 2020-05-19 |
| 1548526783 | William Charles Elston | Surgery | 339 Fairlane Dr, Spartanburg, SC 29307-3840 | 2012-04-02 |
| 1043441736 | Michael G Mount | Surgery | 853 N Church St Ste 500, Spartanburg, SC 29303-3077 | 2009-07-29 |
| 1477508877 | Sylvia S Tarazi | Surgery | 385 Serpentine Dr, Spartanburg, SC 29303-3018 | 2006-05-23 |
| 1306803200 | Ernest Camp IIi | Surgery | 16 Drayton Ct, Spartanburg, SC 29301-6519 | 2006-04-26 |
| 1457316978 | Christope Liem Nguyen | Surgery | 101 E Wood St Fl 3, Spartanburg, SC 29303 | 2006-04-18 |
| 1386607349 | Richard Bennett Reinhardt Jr. | Surgery | 1330 Boiling Springs Rd Ste 2300, Spartanburg, SC 29303 | 2006-04-10 |
| 1659332815 | James D Dunn | Surgery | 324 N Pine St, Spartanburg, SC 29302-1631 | 2006-03-29 |
| 1144297888 | Auburn Woods IIi | Surgery | 1330 Boiling Springs Road, Suite 2300, Spartanburg, SC 29303 | 2006-03-01 |
| 1275505026 | Mark O Smith | Surgery | 1650 Skylyn Dr Ste 240, Spartanburg, SC 29307-1069 | 2006-02-06 |
| Find all providers in SPARTANBURG | ||||
| City | SPARTANBURG |
| Zip Code | 29307 |
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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.