MARY BLACK HEALTH SYSTEM, LLC (NPI# 1588679922) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1588679922 |
Entity Type | Organization |
Organization Name | MARY BLACK HEALTH SYSTEM, LLC |
Other Organization Name | PEDIATRIC ASSOCIATES |
Practice Address |
147 Oakwood Ave Spartanburg SC 29302-1207 |
Mailing Address |
138 Dillon Dr Ste A Spartanburg SC 29307-1018 |
Practice Telephone | 8645828135 |
Mailing Telephone | 8645428980 |
Mailing Fax Number | 8645159994 |
Enumeration Date | 2006-07-31 |
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 |
---|---|---|---|---|---|
N | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers | ||
Y | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
State | Issuer | Identifier | Type Code |
---|---|---|---|
SC | GP2480 | 05 |
Other Name | Type Code |
---|---|
Pediatric Associates | 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 |
1376551713 | Mary Black Health System, LLC | Urology | 1 Doctors Park Dr, Spartanburg, SC 29307-1021 | 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 |
Street Address |
147 OAKWOOD AVE |
City | SPARTANBURG |
State | SC |
Zip Code | 29302-1207 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1619920808 | H Heywood Nettles | Pediatrics | 147 Oakwood Ave, Spartanburg, SC 29302-1207 | 2006-05-18 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1083226476 | Healthstat Inc Grace Management | Preventive Medicine | 951 South Pin Street, Suite 200, Spartanburg, SC 29302 | 2020-08-18 |
1467978304 | Katherine Tomes | Speech-Language Pathologist | 355 Cedar Springs Road, Spartanburg, SC 29302 | 2017-08-22 |
1396291167 | Brent Timothy Smith | Specialist | 151 Ribault Street Suite 200, Spartanburg, SC 29302 | 2016-08-31 |
1376995159 | Natalie Nicole Kellett | Nurse Practitioner | 120 Heywood Avenue Suite 200, Spartanburg, SC 29302 | 2016-07-06 |
1902273808 | Tamieka Latrell Alston-gibson | Nurse Practitioner | 101 North Pine Street, Suite 210, Spartanburg, SC 29302 | 2015-08-26 |
1700209905 | Robert W Wyatt | Pharmacist | 203 Cedar Springs Rd, Spartanburg, SC 29302 | 2014-01-24 |
1952735748 | James Sidney Fulmer Sr. | Obstetrics & Gynecology | 167 Ivy Court, Spartanburg, SC 29302 | 2013-08-28 |
1053651828 | Jennifer Geddes Hall | Counselor | 101 N Pine St Ste 210, Spartanburg, SC 29302 | 2013-02-15 |
1487875514 | Park Place Spartanburg | Assisted Living Facility | 2720 Country Clud Road, Spartanburg, SC 29302 | 2007-05-02 |
1740304401 | Leon Derek Herring | Dentist | 270 Cedar Spring Rd, Spartanburg, SC 29302 | 2007-03-19 |
Find all providers in zip 29302 |
Taxonomy Code | 208000000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Pediatrics |
A pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. |
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 Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certificatio - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1275900961 | Gateway Children's | Pediatrics | 397 Serpentine Dr, Ste B, Spartanburg, SC 29303-3067 | 2015-08-28 |
1447477344 | Ann Marie Harrill Edwards | Pediatrics | 249 North Grove Medical Park Dr, Ste 100, Spartanburg, SC 29603-4222 | 2007-04-20 |
1245393776 | Monique Hope Fox | Pediatrics | 750 South Church Street, Spartanburg, SC 29306 | 2006-12-18 |
1083795934 | Christine Hidalgo Philpott | Pediatrics | 201 E Broad St, Spartanburg, SC 29306-3233 | 2006-10-18 |
1801837968 | William Travis Weathers | Pediatrics | 1650 Skyn Drive, Suite 240, Spartanburg, SC 29307-1069 | 2006-06-09 |
1093769804 | George Chester Glenn IIi | Pediatrics | 1686 Skyland Drive, Suite 201, Spartanburg, SC 29307 | 2006-05-19 |
1386697175 | Michelle Lynn Prigge | Pediatrics | 249 N Grove Medical Park Dr Ste 100, Spartanburg, SC 29303 | 2006-05-19 |
1619920808 | H Heywood Nettles | Pediatrics | 147 Oakwood Ave, Spartanburg, SC 29302-1207 | 2006-05-18 |
1871552315 | Steven Douglas Egge Sr. | Pediatrics | 3020 Reidville Rd Ste B, Spartanburg, SC 29301-5641 | 2006-03-22 |
1891765533 | Shelley Mahaffey | Pediatrics | 8311 Warren H Abernathy Hwy, Spartanburg, SC 29301-1249 | 2006-01-25 |
Find all providers in SPARTANBURG |
City | SPARTANBURG |
Zip Code | 29302 |
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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.