NPIMap

Organization Active NPI

Mary Black Physicians Group, LLC

  • Family Medicine Physician
  • Spartanburg, SC
National Provider Identifier
1124263694
Registry record updated Dec 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARY BLACK PHYSICIANS GROUP, LLC
Practice address
130 Dillon Dr
Spartanburg, SC 29307-1018
Phone
(864) 585-2027
NPI assigned
Dec 11, 2008
Last updated
Dec 11, 2008By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY BLACK PHYSICIANS GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Debbie Brewer
Title
Credentialing Supervisor
Phone
(615) 465-7626

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

130 Dillon Dr
Spartanburg, SC 29307-1018

Mailing address

PO Box 277827
Atlanta, GA 30384-7827
Phone (864) 253-8080

Other identifiers 1

IdentifierTypeStateIssuer
GP4768MedicaidSC

Other names 1

  • Family Medical Center Other name

National Provider Directory

National Provider Directory
Tax ID family
Mary Black Physicians Group33 organizations share this tax ID, including this one
Part of
Mary Black Physicians Group

Other organizations with this tax ID 32

Organizations that report the same tax identification number in the National Provider Directory.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1228953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228953600000",
    "number": "1124263694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 277827",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303847827",
            "telephone_number": "864-253-8080",
            "fax_number": "864-582-5188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 DILLON DR",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071018",
            "telephone_number": "864-585-2027"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK PHYSICIANS GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK PHYSICIANS GROUP, LLC",
        "enumeration_date": "2008-12-11",
        "last_updated": "2008-12-11",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "CREDENTIALING SUPERVISOR",
        "authorized_official_telephone_number": "615-465-7626"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4768",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.