Organization
SAMUEL A BLACK, MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL A BLACK SR. MD (PRESIDENT)
(800) 228-0249
Entity
Organization
Contact information
Practice address
129 N WASHINGTON ST, SUMTER, SC 29150-4949
(800) 228-0249
(252) 222-3602
Mailing address
PO BOX 39, MOREHEAD CITY, NC 28557-0039
(800) 228-0249
(252) 222-3602
Taxonomy
Speciality
Code
Description
License number
State
225400000X
Rehabilitation Practitioner
Primary
MD5514
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
055148
—
SC
Enumeration date
10/09/2006
Last updated
08/22/2020
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