Mary Black Physicians Group LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MARY BLACK PHYSICIANS GROUP LLC

Practice address

1686 Skylyn Dr
Suite 101
Spartanburg, SC 29307-1058

Phone

(864) 585-3456

NPI assigned

Apr 24, 2007

Last updated

Jun 11, 2009By 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": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244678400000",
    "number": "1609094481",
    "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": "864-585-3456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1686 SKYLYN DR",
            "address_2": "SUITE 101",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071058",
            "telephone_number": "864-585-3456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK PHYSICIANS GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2009-06-11",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• 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
• 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 Jun 11, 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.