Mary Black Physicians Group LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MARY BLACK PHYSICIANS GROUP LLC

Doing business as

Mary Black Family Medicine Dorman

Practice address

5229 Hwy 221
Roebuck, SC 29376-3305

Phone

(864) 576-8193

NPI assigned

Dec 3, 2008

Last updated

Feb 26, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

MARY BLACK PHYSICIANS GROUP LLCAs reported in NPPES

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

Authorized official

Name

Debbie Brewer

Title

Director

Phone

(877) 892-9813

Specialties & licenses 1

Addresses

Other names 1

• Mary Black Family Medicine Dorman Doing business as

Part of

Emary Black Physicians Group LLC

Locations

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

{
    "created_epoch": "1228262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1235606400000",
    "number": "1164667283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5229 HWY 221",
            "city": "ROEBUCK",
            "state": "SC",
            "postal_code": "293763305",
            "telephone_number": "864-576-8193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5229 HWY 221",
            "city": "ROEBUCK",
            "state": "SC",
            "postal_code": "293763305",
            "telephone_number": "864-576-8193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK PHYSICIANS GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK PHYSICIANS GROUP LLC",
        "enumeration_date": "2008-12-03",
        "last_updated": "2009-02-26",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "877-892-9813"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "SC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Black Family Medicine Dorman",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jennifer Wren Lever, DMD
• Joseph Kayne Lever, DMD
• Susan S Lueck, R.N.
• Kim Annette Lukridge, RN
• Alison Markey
• Mary Black Physicians Group LLC (Mary Black Family Medicine Dorman)
• Mary Black Physicians Group, LLC
• Latoya McBeth
• Missing Pieces Counseling Services, LLC
• Leiloni N Nix, M.S.,SLP

• Durable Medical Equipment & Medical Supplies in Roebuck, SC
• Providers in Roebuck, SC by specialty
• Durable Medical Equipment & Medical Supplies in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2009; 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.