| Organization Name: | MARY BLACK PHYSICIANS GROUP LLC |
| NPI Number: | 1457555120 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | V KAREN FLINN (VP) |
| Mailing Address: | 108 W Rutherford St Landrum |
| State: | SC US |
| Postal Code: | 293561526 |
| Phone Number: | 8344754703 |
| Fax Number: | 8644572736 |
| NPI Enumeration Date: | 06/14/2007 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |