Organization
MARY BLACK PHYSICIANS GROUP LLC
Active
Parent organization
MARY BLACK PHYSICIANS GROUP, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MARY BLACK PHYSICIANS GROUP, LLC
Authorized official
DONNA L MATTSON (SENIOR CREDENTIALING COORDINATOR)
(214) 473-7043
Entity
Organization
Contact information
Practice address
148 DILLON DR, SPARTANBURG, SC 29307-1018
(864) 582-1089
Mailing address
148 DILLON DR, SPARTANBURG, SC 29307-1018
(864) 582-1089
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
04/24/2007
Last updated
08/13/2008
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