Healthcare Provider Details

I. General information

NPI: 1710995105
Provider Name (Legal Business Name): MARY BLACK HEALTH SYSTEM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 DILLON DR
SPARTANBURG SC
29307-1017
US

IV. Provider business mailing address

138 DILLON DR STE A
SPARTANBURG SC
29307-1018
US

V. Phone/Fax

Practice location:
  • Phone: 864-585-8064
  • Fax:
Mailing address:
  • Phone: 864-542-8980
  • Fax: 864-515-9994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: REBECCA HURLEY
Title or Position: SENIOR VICE PRESIDENT
Credential:
Phone: 214-473-3993