MARY BLACK PHYSICIANS GROUP, LLC (NPI# 1053556522) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1053556522 |
| Entity Type | Organization |
| Organization Name | MARY BLACK PHYSICIANS GROUP, LLC |
| Other Organization Name | FAMILY PHYSICIANS OF SPARTANBURG |
| Practice Address |
1250 John B White Sr Blvd Spartanburg SC 29306-3929 |
| Mailing Address |
Po Box 277827 Atlanta GA 30384-7827 |
| Practice Telephone | 8645769201 |
| 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 | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP4767 | 05 |
| Other Name | Type Code |
|---|---|
| Family Physicians of Spartanburg | 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 |
| 1295970770 | Mary Black Physicians Group, LLC | Surgery | 1690 Skylyn Dr, Suite 140, Spartanburg, SC 29307-1022 | 2008-12-11 |
| 1104061688 | Mary Black Physicians Group, LLC | Emergency Medicine | 2995 Reidville Rd, Spartanburg, SC 29301-5628 | 2008-12-11 |
| Street Address |
1250 JOHN B WHITE SR BLVD |
| City | SPARTANBURG |
| State | SC |
| Zip Code | 29306-3929 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447246616 | Lisa B Colasurdo | Nurse Practitioner | 1250 John B White Sr Blvd, Spartanburg, SC 29306-3929 | 2005-09-23 |
| 1174850028 | Amy Britain Krahl | Physician Assistant | 1250 John B White Sr Blvd, Spartanburg, SC 29306-3929 | 2009-11-13 |
| 1730306788 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 1250 John B White Sr Blvd, Spartanburg, SC 29306-3929 | 2007-04-19 |
| 1003966367 | Jian Wu | Physician Assistant | 1250 John B White Sr Blvd, Spartanburg, SC 29306-3929 | 2007-01-11 |
| 1710094388 | Mary Black Health System, LLC | Internal Medicine | 1250 John B White Sr Blvd, Spartanburg, SC 29306-3929 | 2006-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487111738 | Paladina Health, LLC | Family Medicine | Paladina Health Spartanburg Palmetto Bank, 101 West Saint John Street Suite 107, Spartanburg, SC 29306 | 2019-02-22 |
| 1295253441 | Michael Neal Quinn | Chiropractor | 851 John B White Sr Blvd, Spartanburg, SC 29306 | 2017-09-07 |
| 1003347980 | T and T Home Health Care | Home Health | 1315 John B White Sr Blvd, Spartanburg, SC 29306 | 2017-03-23 |
| 1942601174 | Carolina Dental Docs LLC General Dentistry for Kids | Dentist | 1460 John B White Sr Blvd, Ste 1-c, Spartanburg, SC 29306 | 2014-09-08 |
| 1801237375 | Jireh Services,llc | Specialist | 180 John B. White Sr. Blvd, Spartanburg, SC 29306 | 2013-07-12 |
| 1811268683 | Rochelle Janene Delain | Chiropractor | 1425 John B. White, Sr. Boulevard, Spartanburg, SC 29306 | 2012-01-25 |
| 1366602229 | Jasjot K. Bhullar | Internal Medicine | 1410-b John B. White Sr. Boulevard, Spartanburg, SC 29306 | 2008-06-13 |
| 1356543045 | Cheryl B Haman | Counselor | 200 Ezell Street, Spartanburg, SC 29306 | 2007-06-04 |
| 1821142506 | Paula F Wilson | Counselor | 335 Caulder Ave, Spartanburg, SC 29306 | 2007-01-22 |
| 1154473163 | Ronald E Marshall Dds Pa | Dentist | 1410 John B White Sr Blvd, Spartanburg, SC 29306 | 2007-01-18 |
| Find all providers in zip 29306 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033716253 | Proactive Md Tindall Spartanburg Health Center | Family Medicine | 2273 Hayne St., Spartanburg, SC 29301 | 2020-10-01 |
| 1013532126 | Adam Joseph Fulcher | Family Medicine | Center for Family Medicine, 853 N. Church Street, Suite 510, Spartanburg, SC 29303 | 2020-06-15 |
| 1538713813 | Proactive Md Sc,p.a. | Family Medicine | 101 W Saint John St Ste 107, Spartanburg, SC 29306-5157 | 2019-07-25 |
| 1073171336 | Proactive Md Sc,p.a. | Family Medicine | 801 Union St, Spartanburg, SC 29302-2734 | 2019-06-03 |
| 1841757192 | Paladina Health, LLC | Family Medicine | Paladina Health Smith Drug, 9098 Fairforest Road, Spartanburg, SC 29301 | 2019-02-22 |
| 1487111738 | Paladina Health, LLC | Family Medicine | Paladina Health Spartanburg Palmetto Bank, 101 West Saint John Street Suite 107, Spartanburg, SC 29306 | 2019-02-22 |
| 1649735127 | Spartanburg Medical Center | Family Medicine | 11 Doctors Park Dr Ste 200, Spartanburg, SC 29307-1008 | 2019-02-08 |
| 1114403342 | Piedmont Care, Inc. | Family Medicine | 101 N Pine St Ste 200, Spartanburg, SC 29302-1604 | 2018-07-11 |
| 1356871933 | Kristy Kaye Atkinson | Family Medicine | 853 N Church St # 150, Spartanburg, SC 29303-3098 | 2017-06-15 |
| 1003352261 | Academic Primary Care Associates | Family Medicine | 410 Magnolia St, Spartanburg, SC 29303-3640 | 2017-01-12 |
| Find all providers in SPARTANBURG | ||||
| City | SPARTANBURG |
| Zip Code | 29306 |
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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.