Michael T Black

Primary specialty

Attendant Care ProviderTaxonomy code 3747A0650X

License

1922258 Issued in OR

Practice address

317 Lad LN
Roseburg, OR 97471-4420

Phone

(541) 393-4138

NPI assigned

Oct 17, 2024

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1729123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729123200000",
    "number": "1316768872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "317 LAD LN",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974714420",
            "telephone_number": "541-393-4138"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "317 LAD LN",
            "city": "ROSEBURG",
            "state": "OR",
            "postal_code": "974714420",
            "telephone_number": "541-393-4138"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MICHAEL",
        "middle_name": "T",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-17",
        "last_updated": "2024-10-17",
        "certification_date": "2024-10-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "",
            "desc": "Technician, Attendant Care Provider",
            "state": "OR",
            "license": "1922258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Douglas A Bitter, MD
• Wendy Rose Black Helbling
• Frederick J Black, MD
• Joseph M Black, M D
• Judy Black, M.D.
• Thomas A Black
• Hayley Blackburn, PHARM.D., BCACP
• Alexandra Ann Blaine
• Carly Blemmel, MSHR. LPC
• Holly Block, MA, NCC

• Attendant Care Provider in Roseburg, OR
• Providers in Roseburg, OR by specialty
• Attendant Care Provider in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2024; 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.