Provider Demographics
NPI:1942495551
Name:MARY BLACK HEALTH SYSTEM LLC
Entity Type:Organization
Organization Name:MARY BLACK HEALTH SYSTEM LLC
Other - Org Name:WOMENS HEALTH CARE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-465-7626
Mailing Address - Street 1:1686 SKYLYN DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1058
Mailing Address - Country:US
Mailing Address - Phone:864-542-1804
Mailing Address - Fax:864-542-9305
Practice Address - Street 1:1686 SKYLYN DR
Practice Address - Street 2:SUITE 201
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1058
Practice Address - Country:US
Practice Address - Phone:864-542-1804
Practice Address - Fax:864-542-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0456110021OtherMEDICARE DME PIN