NPIMap

Organization Active NPI

Mary Black Physicians Group, LLC

  • Internal Medicine Physician
  • Union, SC
National Provider Identifier
1326283938
Registry record updated Dec 10, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
MARY BLACK PHYSICIANS GROUP, LLC
Practice address
1005 Thompson Blvd
Union, SC 29379-7409
Phone
(864) 427-9311
Fax
(864) 427-9319
NPI assigned
Dec 10, 2008
Organization subpart
Yes
Parent organization
MARY BLACK PHYSICIANS GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 10, 2008

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

Authorized official

Name
Debbie Brewer
Title
Director Provider Enrollment
Phone
(615) 465-7626

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

1005 Thompson Blvd
Union, SC 29379-7409

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
GP4762MedicaidSC

Other names 1

  • Carolina Internal Medicine of Union 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": "1228867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228867200000",
    "number": "1326283938",
    "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": "1005 THOMPSON BLVD",
            "city": "UNION",
            "state": "SC",
            "postal_code": "293797409",
            "telephone_number": "864-427-9311",
            "fax_number": "864-427-9319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK PHYSICIANS GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK PHYSICIANS GROUP, LLC",
        "enumeration_date": "2008-12-10",
        "last_updated": "2008-12-10",
        "status": "A",
        "authorized_official_last_name": "BREWER",
        "authorized_official_first_name": "DEBBIE",
        "authorized_official_title_or_position": "DIRECTOR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "615-465-7626"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP4762",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Carolina Internal Medicine of Union",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Union, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 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.