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General NPI Number Information
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NPI Number | 1083640981
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Entity Type | Organization
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Legal Business Name | MARY BLACK HEALTH SYSTEM LLC
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 1700 SKYLYN DR
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City | SPARTANBURG
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State | SC
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Zip | 29307-1041
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Country | US
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Telephone | 864-573-3000
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Fax | 864-573-3277
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Provider Business Mailing Address
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Address Line | 1700 SKYLYN DR PO BOX 3217
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City | SPARTANBURG
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State | SC
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Zip | 29307-1041
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Country | US
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Telephone | 864-573-3000
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Fax | 864-573-3277
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Authorized Official
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Title or Position | SENIOR VICE PRESIDENT
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Name | REBECCA HURLEY
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Credential |
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Telephone | 214-473-3993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | HTL-704
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License Number State | SC
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Taxonomy #2
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Taxonomy Code | 207RC0001X
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Taxonomy Name | Clinical Cardiac Electrophysiology Physician
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License Number | HTL-704
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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