Active NPI
Mary Black Physicians Group LLC
- Durable Medical Equipment & Medical Supplies
- Spartanburg, SC
National Provider Identifier
1376761155
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Durable Medical Equipment & Medical Supplies
- Legal business name
- MARY BLACK PHYSICIANS GROUP LLC
- Practice address
- 148 Dillon Dr
Spartanburg, SC 29307-1018 - Phone
- (864) 582-1089
- NPI assigned
- Apr 24, 2007
- Last updated
- Aug 13, 2008
- Organization subpart
- Yes
- Parent organization
- MARY BLACK PHYSICIANS GROUP, LLC
NPPES NPI Registry
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
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Durable Medical Equipment & Medical Supplies | 332B00000X | NU | Primary |
Addresses
Primary practice location
148 Dillon Dr
Spartanburg, SC 29307-1018
Mailing address
148 Dillon Dr
Spartanburg, SC 29307-1018
Phone (864) 582-1089
National Provider Directory
National Provider Directory- Part of
- Emary Black Physicians Group LLC
Locations
148 Dillon Dr
Spartanburg, SC 29307
Phone (864) 582-1082
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177372800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1218585600000",
"number": "1376761155",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "148 DILLON DR",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293071018",
"telephone_number": "864-582-1089"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "148 DILLON DR",
"city": "SPARTANBURG",
"state": "SC",
"postal_code": "293071018",
"telephone_number": "864-582-1089"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MARY BLACK PHYSICIANS GROUP LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "MARY BLACK PHYSICIANS GROUP, LLC",
"enumeration_date": "2007-04-24",
"last_updated": "2008-08-13",
"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": []
}Other providers in Spartanburg, SC
- 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
- Mary Black Physicians Group LLC (Westside Minor Car)
- Mary Black Physicians Group LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.