NPIMap

Organization Active NPI

Mary Black Physicians Group, LLC

  • Gastroenterology Physician
  • Spartanburg, SC
National Provider Identifier
1568607190
Registry record updated Jan 8, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
MARY BLACK PHYSICIANS GROUP, LLC
Practice address
11 Doctors Park Dr
Suite 240
Spartanburg, SC 29307-1024
Phone
(864) 573-3593
NPI assigned
Dec 11, 2008
Last updated
Jan 8, 2009By the provider in NPPES
Organization subpart
Yes
Parent organization
MARY BLACK PHYSICIANS GROUP, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 8, 2009

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
Gastroenterology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207RG0100X Primary

Addresses

Primary practice location

11 Doctors Park Dr
Suite 240
Spartanburg, SC 29307-1024

Mailing address

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

Other names 1

  • Mary Black Gastroenterology Associates 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": "1228953600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231372800000",
    "number": "1568607190",
    "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": "11 DOCTORS PARK DR",
            "address_2": "SUITE 240",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071024",
            "telephone_number": "864-573-3593"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK PHYSICIANS GROUP, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MARY BLACK PHYSICIANS GROUP, LLC",
        "enumeration_date": "2008-12-11",
        "last_updated": "2009-01-08",
        "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": "207RG0100X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Black Gastroenterology Associates",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 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.