Mary Black Physicians Group LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MARY BLACK PHYSICIANS GROUP LLC

Practice address

145 Dillon Dr # B
Spartanburg, SC 29307-1017

Phone

(864) 582-7892

NPI assigned

Apr 23, 2007

Last updated

Jul 2, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Donna L Mattson

Title

Senior Credentialing Coordinator

Phone

(214) 473-7043

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1177286400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1235357260",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 DILLON DR # B",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071017",
            "telephone_number": "864-582-7892"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK PHYSICIANS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-23",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "MATTSON",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SENIOR CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "214-473-7043"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Black Physician Services, LLC (Steadman Hawkins Clinic of the Carolinas)
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC (Mary Black Minor Care Center)
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC
• Mary Black Physicians Group LLC

• Durable Medical Equipment & Medical Supplies in Spartanburg, SC
• Providers in Spartanburg, 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 Jul 2, 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.