# SAMUEL A BLACK, MD, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265529499
- **Authorized official:** SAMUEL A BLACK SR. MD (PRESIDENT)
- **Authorized official phone:** (800) 228-0249

## Contact information

- **Practice address:** 129 N WASHINGTON ST, SUMTER, SC 29150-4949
- **Practice address phone:** (800) 228-0249
- **Practice address fax:** (252) 222-3602
- **Mailing address:** PO BOX 39, MOREHEAD CITY, NC 28557-0039
- **Mailing address phone:** (800) 228-0249
- **Mailing address fax:** (252) 222-3602

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 225400000X | Rehabilitation Practitioner | MD5514 | SC | Yes |

## Other

- **Enumeration date:** 10/09/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 055148 | — | SC |