MARY BLACK HEALTH SYSTEM, LLC (NPI# 1376551713) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1376551713 |
| Entity Type | Organization |
| Organization Name | MARY BLACK HEALTH SYSTEM, LLC |
| Other Organization Name | BASS UROLOGY |
| Practice Address |
1 Doctors Park Dr Spartanburg SC 29307-1021 |
| Mailing Address |
138 Dillon Dr Ste A Spartanburg SC 29307-1018 |
| Practice Telephone | 8645852587 |
| Practice Fax Number | 8645852141 |
| Mailing Telephone | 8645428980 |
| Mailing Fax Number | 8645159994 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-08-14 |
| Authorized Official Name | DEBBIE BREWER (DIRECTOR OF PROVIDER ENROLLMENT) |
| Authorized Official Telephone | 6154657000 |
| Is Organization Subpart | Y |
| Parent Organization Name | MARY BLACK HEALTH SYSTEM, LLC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP3679 | 05 |
| Other Name | Type Code |
|---|---|
| Bass Urology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518074194 | Mary Black Health System, LLC | Obstetrics & Gynecology | 1686 Skylyn Dr Ste 101, Spartanburg, SC 29307-1058 | 2006-08-23 |
| 1629087754 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 2995 Reidville Rd Ste 260, Spartanburg, SC 29301-5667 | 2006-08-07 |
| 1679582712 | Mary Black Health System, LLC | Obstetrics & Gynecology | 2995 Reidville Rd Ste 290, Spartanburg, SC 29301-5667 | 2006-08-07 |
| 1710995105 | Mary Black Health System, LLC | Obstetrics & Gynecology | 123 Dillon Dr, Spartanburg, SC 29307-1017 | 2006-08-03 |
| 1932117389 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 245 E Blackstock Rd, Spartanburg, SC 29301-2633 | 2006-08-03 |
| 1871500843 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 145b Dillon Dr, Spartanburg, SC 29307-1017 | 2006-08-02 |
| 1073529699 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 1605 Drayton Ave, Spartanburg, SC 29305 | 2006-08-01 |
| 1528075082 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 138 Dillon Dr Ste A, Spartanburg, SC 29307-1018 | 2006-08-01 |
| 1922013721 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 2212 Old Furnace Rd, Boiling Springs, SC 29316-5782 | 2006-07-30 |
| 1770506990 | Mary Black Health System, LLC | Family Medicine | 130 Dillon Dr, Spartanburg, SC 29307-1018 | 2006-07-26 |
| Street Address |
1 DOCTORS PARK DR |
| City | SPARTANBURG |
| State | SC |
| Zip Code | 29307-1021 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093933848 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 1 Doctors Park Dr, Suite B, Spartanburg, SC 29307-1021 | 2007-04-24 |
| 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 | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467893404 | Robert Strehlow Vi | Urology | 391 Serpentine Dr Ste 500, Spartanburg, SC 29303-3083 | 2013-07-06 |
| 1598717951 | R Bruce Bass | Urology | 1 Doctors Park Drive, Suite B, Spartanburg, SC 29307-1008 | 2006-05-16 |
| 1689143786 | Spartanburg Medical Center | Urology | 11 Doctors Park Dr Ste 220, Spartanburg, SC 29307-1008 | 2018-11-19 |
| 1821226960 | Erin Anderson | Urology | 391 Serpentine Dr, Suite 500, Spartanburg, SC 29303-3096 | 2009-06-28 |
| 1699711317 | Michael B Pryor | Urology | 391 Serpentine Dr, Suite 200, Spartanburg, SC 29303-3083 | 2006-06-21 |
| 1639130628 | Gerald W Hull IIi | Urology | 391 Serpentine Dr, Suite 500, Spartanburg, SC 29303-3083 | 2006-03-29 |
| 1093775926 | Robert G Britanisky | Urology | 391 Serpentine Dr., Suite500, Spartanburg, SC 29303-3083 | 2006-03-24 |
| 1356317325 | Paul T Ellis | Urology | 391 Serpentine Dr, Suite 500, Spartanburg, SC 29303-3083 | 2006-02-28 |
| 1912903659 | Michael Curtis Staley | Urology | 391 Serpentine Dr, Suite 500, Spartanburg, SC 29303-3096 | 2005-06-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295393098 | Christopher William Ritchie | Urology | 135 Rutledge Ave Fl 5, Charleston, SC 29425-8903 | 2019-06-05 |
| 1780248211 | Spartanburg Medical Center | Urology | 2755 S Highway 14 Ste 2050a, Greer, SC 29650-4902 | 2019-04-30 |
| 1609345982 | Spartanburg Medical Center | Urology | 1552 N Limestone St Ste A, Gaffney, SC 29340-4750 | 2018-11-16 |
| 1942775952 | Roper Saint Francis Physicians Network | Urology | 300 Callen Blvd Ste 220, Summerville, SC 29486-2809 | 2018-10-05 |
| 1790131522 | Urology Clinic At Carolinas | Urology | 1594 Freedom Blvd Ste 203, Florence, SC 29505-6046 | 2016-05-11 |
| 1912368457 | Urology Clinic, Inc. | Urology | 1285 Wilson Hall Rd, Sumter, SC 29150 | 2016-03-11 |
| 1154700367 | Gregory Slachta | Urology | 407 Broadview Dr, Ridgeland, SC 29936-5157 | 2015-05-20 |
| 1326487588 | Tracy Jon Tipton | Urology | 125 Doughty St Ste 300, Charleston, SC 29403 | 2013-06-21 |
| 1790121424 | Philip Andre Fontenot Jr. | Urology | 50 Bear Dr, Greenville, SC 29605 | 2013-05-21 |
| 1679828750 | Thomas Alexander Kirkland Jr. | Urology | 2 Ladson St, Apt. A, Charleston, SC 29401-2757 | 2012-07-16 |
| Find all providers with the same taxonomy | ||||
| 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.