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General NPI Number Information
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NPI Number | 1336344852
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Entity Type | Organization
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Legal Business Name | MARY BLACK PHYSICIANS GROUP LLC
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/08/2008
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Provider Practice Location Address
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Address Line | 5229 HIGHWAY 221
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City | ROEBUCK
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State | SC
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Zip | 29376-3305
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Country | US
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Telephone | 864-576-8193
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Fax |
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Provider Business Mailing Address
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Address Line | 5229 HIGHWAY 221
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City | ROEBUCK
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State | SC
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Zip | 29376-3305
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Country | US
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Telephone | 864-576-8193
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | DEBBIE T BREWER
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Credential |
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Telephone | 877-892-9813
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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