Provider Demographics
NPI:1447883293
Name:WEBB, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WEBB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:658 BULTMAN DRIVE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2550
Mailing Address - Country:US
Mailing Address - Phone:803-316-4689
Mailing Address - Fax:
Practice Address - Street 1:658 BULTMAN DRIVE
Practice Address - Street 2:SUITE Q
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2550
Practice Address - Country:US
Practice Address - Phone:803-316-4689
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCIHCP-1135251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health