MARY BLACK PHYSICIANS GROUP, LLC (NPI# 1487899969) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1487899969 |
| Entity Type | Organization |
| Organization Name | MARY BLACK PHYSICIANS GROUP, LLC |
| Other Organization Name | PEDIATRICS ASSOICATES-WEST |
| Practice Address |
500 Squires Pt Suite A Duncan SC 29334-8867 |
| Mailing Address |
Po Box 277827 Atlanta GA 30384-7827 |
| Practice Telephone | 8644330369 |
| 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 | 208000000X | Pediatrics | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SC | GP4780 | 05 |
| Other Name | Type Code |
|---|---|
| Pediatrics Assoicates-West | 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 |
| 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 |
| 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 |
500 SQUIRES PT SUITE A |
| City | DUNCAN |
| State | SC |
| Zip Code | 29334-8867 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306872080 | Edward J Mea | Family Medicine | 500 Squires Pt, Duncan, SC 29334 | 2006-06-24 |
| 1235572298 | Vinay Jay Patidar | Family Medicine | 500 Squires Pt, Duncan, SC 29334-8867 | 2013-04-09 |
| 1952546426 | Mary Black Physicians Group, LLC | Family Medicine | 500 Squires Pt, Suite B, Duncan, SC 29334-8867 | 2008-12-11 |
| 1629272331 | Antoinette Denise Rhynes | Family Medicine | 500 Squires Pt, Duncan, SC 29334-8867 | 2007-06-14 |
| 1518187228 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 500 Squires Pt, Suite B, Duncan, SC 29334-8867 | 2007-04-26 |
| 1093933855 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 500 Squires Pt, Suite A, Duncan, SC 29334-8867 | 2007-04-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487032272 | Polly Wright Rector | Specialist | 120 S Spencer St, Duncan, SC 29334 | 2015-05-12 |
| 1417343286 | Rubina Batool Baksh | Pediatrics | 500 Squires Pt Ste A, Duncan, SC 29334 | 2015-04-08 |
| 1922274463 | Joseph Brandon Chadwell | Dentist | 705 Squires Pt, Duncan, SC 29334 | 2008-05-05 |
| 1306068127 | Worth Family Chiropractic | Chiropractor | 1531 E Main St #2, Duncan, SC 29334 | 2007-05-02 |
| 1912031717 | Laura Ann Gray | Speech-Language Pathologist | 407 Caperton Way, Duncan, SC 29334 | 2007-03-15 |
| 1457429078 | Spartanburg County School District No. 5 | Registered Nurse | 100 N. Danzler Rd, Duncan, SC 29334 | 2006-12-01 |
| 1003913328 | World Class Healthcare Pa | Chiropractor | 700 Squire's Pt, Ste. B, Duncan, SC 29334 | 2006-09-20 |
| 1245348242 | Craig Bernard Pruitt | Optometrist | Vision Plus 1955 E Main St, 1955 East Main St. Suite C., Duncan, SC 29334 | 2006-08-29 |
| 1861415085 | Mary Black Health System LLC | Family Medicine | 500 Squires Pointe, Duncan, SC 29334 | 2006-07-26 |
| 1982622585 | Derek T Dunlap | Dentist | 700 Squire's Pointe Drive, Suite A, Duncan, SC 29334 | 2006-07-18 |
| Find all providers in zip 29334 | ||||
| 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 |
|---|---|---|---|---|
| 1417343286 | Rubina Batool Baksh | Pediatrics | 500 Squires Pt Ste A, Duncan, SC 29334 | 2015-04-08 |
| 1740416395 | Sanford Clinic | Pediatrics | 2502 W. Elk Ave., Duncan, OK 73533 | 2009-06-09 |
| 1336678564 | Mina Joseph | Pediatrics | 2502 W Elk Ave, Duncan, OK 73533-1562 | 2017-06-10 |
| 1982683488 | Deena Renae Wise | Pediatrics | 2502 W Elk Ave, Duncan, OK 73533-1562 | 2006-01-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750981833 | Kaitlyn Marie Skelston | Pediatrics | 2828 Bayboro St, Loris, SC 29569-2710 | 2020-10-28 |
| 1518571421 | Carolinas Physicians Network Inc | Pediatrics | 1154 Carolina Pl, Fort Mill, SC 29708-7063 | 2020-09-08 |
| 1952911075 | Medical University Hospital Authority | Pediatrics | 838 W Meeting St Ste E, Lancaster, SC 29720-6261 | 2020-08-04 |
| 1134738644 | Medical University Hospital Authority | Pediatrics | 1 Medical Park Dr Ste A, Chester, SC 29706-9769 | 2020-07-30 |
| 1023632809 | Caitlin Marie Stoll | Pediatrics | 2244 Ashley Crossing Dr Unit 536, Charleston, SC 29414-6168 | 2020-06-08 |
| 1972128742 | Emily Anne Cloessner | Pediatrics | Prisma Health Childrens Hospital Outpatient Center, 14 Medical Park, Ste 400, Columbia, SC 29203 | 2020-06-08 |
| 1134743420 | Elizabeth Alden Mccants | Pediatrics | 125 Doughty St Ste 520d, Charleston, SC 29403-5736 | 2020-06-02 |
| 1043833890 | Lauren F. Cook | Pediatrics | Prisma Health Children's Hospital Outpatient Center, 14 Medical Park, Ste 400, Columbia, SC 29203 | 2020-05-27 |
| 1619598158 | Zeel Hiren Patel | Pediatrics | Childrens Hospital Outpatient Center, 14 Medical Park, Ste 400, Columbia, SC 29203 | 2020-05-06 |
| 1265066658 | Sahar Alavi | Pediatrics | 1439 Cambridge Lakes Dr, Mount Pleasant, SC 29464-7301 | 2020-02-25 |
| Find all providers with the same taxonomy | ||||
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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.