MARY BLACK HEALTH SYSTEM, LLC (NPI# 1710995105) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1710995105 |
Entity Type | Organization |
Organization Name | MARY BLACK HEALTH SYSTEM, LLC |
Other Organization Name | KIESAU GYNECOLOGY ASSOCIATES |
Practice Address |
123 Dillon Dr Spartanburg SC 29307-1017 |
Mailing Address |
138 Dillon Dr Ste A Spartanburg SC 29307-1018 |
Practice Telephone | 8645858064 |
Mailing Telephone | 8645428980 |
Mailing Fax Number | 8645159994 |
Enumeration Date | 2006-08-03 |
Last Update Date | 2020-08-22 |
Authorized Official Name | REBECCA HURLEY (SENIOR VICE PRESIDENT) |
Authorized Official Telephone | 2144733993 |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
X | 207V00000X | Obstetrics & Gynecology | Allopathic & Osteopathic Physicians | ||
X | 207VG0400X |
Obstetrics & Gynecology Specialization: Gynecology |
Allopathic & Osteopathic Physicians | ||
X | 207VX0000X |
Obstetrics & Gynecology Specialization: Obstetrics |
Allopathic & Osteopathic Physicians | ||
X | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
SC | GP3445 | 05 |
Other Name | Type Code |
---|---|
Kiesau Gynecology Associates | Doing Business As Name - Organization |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1518074194 | Mary Black Health System, LLC | Obstetrics & Gynecology | 1686 Skylyn Dr Ste 101, Spartanburg, SC 29307-1058 | 2006-08-23 |
1629087754 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 2995 Reidville Rd Ste 260, Spartanburg, SC 29301-5667 | 2006-08-07 |
1679582712 | Mary Black Health System, LLC | Obstetrics & Gynecology | 2995 Reidville Rd Ste 290, Spartanburg, SC 29301-5667 | 2006-08-07 |
1376551713 | Mary Black Health System, LLC | Urology | 1 Doctors Park Dr, Spartanburg, SC 29307-1021 | 2006-08-03 |
1932117389 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 245 E Blackstock Rd, Spartanburg, SC 29301-2633 | 2006-08-03 |
1871500843 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 145b Dillon Dr, Spartanburg, SC 29307-1017 | 2006-08-02 |
1073529699 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 1605 Drayton Ave, Spartanburg, SC 29305 | 2006-08-01 |
1528075082 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 138 Dillon Dr Ste A, Spartanburg, SC 29307-1018 | 2006-08-01 |
1922013721 | Mary Black Health System, LLC | Durable Medical Equipment & Medical Supplies | 2212 Old Furnace Rd, Boiling Springs, SC 29316-5782 | 2006-07-30 |
1770506990 | Mary Black Health System, LLC | Family Medicine | 130 Dillon Dr, Spartanburg, SC 29307-1018 | 2006-07-26 |
Street Address |
123 DILLON DR |
City | SPARTANBURG |
State | SC |
Zip Code | 29307-1017 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235794264 | Hospice Care of South Carolina, Lowcountry, LLC | Hospice Care, Community Based | 123 Dillon Dr, Spartanburg, SC 29307-1017 | 2019-05-06 |
1548420755 | Neurologic Care of Spartanburg Pa | Psychiatry & Neurology | 123 Dillon Dr, Spartanburg, SC 29307-1017 | 2008-06-11 |
1770701534 | Mary Black Physicians Group LLC | Durable Medical Equipment & Medical Supplies | 123 Dillon Dr, Spartanburg, SC 29307-1017 | 2007-04-24 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1023677945 | Healogics Specialty Physicians of South Carolina, LLC | Clinic/Center | 1630 Skylyn Drive, Suite 420, Spartanburg, SC 29307 | 2019-06-13 |
1194247528 | Tawnia Lee Prince | Occupational Therapy Assistant | 110 Summit Knoll Drive, Spartanburg, SC 29307 | 2017-07-07 |
1730633553 | Laura K Taylor | Chiropractor | 1802 Drayton Road, Suite 309, Spartanburg, SC 29307 | 2016-08-10 |
1013372390 | Erin Lavette Farr | Nurse Practitioner | 2780 East Main Street, Ltc Health Solutions, Spartanburg, SC 29307 | 2015-12-30 |
1316312010 | Joy Rogers | Speech-Language Pathologist | 175 Burdette St, Spartanburg, SC 29307 | 2015-12-07 |
1376923169 | Olivia Conrad | Speech-Language Pathologist | 220 Sloans Grove Rd, Spartanburg, SC 29307 | 2015-06-05 |
1457755118 | Optimal Radiology Partners of Virginia, Pllc | Radiology | 75 Skylyn Drive, Spartanburg, SC 29307 | 2014-10-09 |
1295033272 | Sean Quinn | Pharmacist | 790 East Main Street, Spartanburg, SC 29307 | 2011-03-01 |
1417250887 | James Edward Bradof | Internal Medicine | 212 Cypress Creek Drive, Spartanburg, SC 29307 | 2010-12-07 |
1528388030 | Tanya Tocharoen Tang | Internal Medicine | 126 Dillon Dr., Spartanburg, SC 29307 | 2010-06-07 |
Find all providers in zip 29307 |
Taxonomy Code | 207V00000X |
Grouping | Allopathic & Osteopathic Physicians |
Classification | Obstetrics & Gynecology |
An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1952735748 | James Sidney Fulmer Sr. | Obstetrics & Gynecology | 167 Ivy Court, Spartanburg, SC 29302 | 2013-08-28 |
1518306059 | Misty L Mcdowell | Obstetrics & Gynecology | 853 N Church St Ste 610, Spartanburg, SC 29303-3070 | 2013-06-18 |
1437248259 | Christy Grant Kobes | Obstetrics & Gynecology | 211 Indian Wells Dr, Spartanburg, SC 29306-6669 | 2006-10-12 |
1043251291 | Kristine Dee Boyd | Obstetrics & Gynecology | 853 N Church St Ste 700, Spartanburg, SC 29303 | 2006-06-09 |
1699729459 | Aaron M Toler | Obstetrics & Gynecology | 1686 Skylyn Drive, Suite 101, Spartanburg, SC 29307 | 2006-05-19 |
1598722290 | Mary Haddad | Obstetrics & Gynecology | 250 North Grove Medical Park Dr, Spartanburg, SC 29303-4222 | 2006-04-27 |
1285696690 | Peter Arnold Sereque | Obstetrics & Gynecology | 250 N Grove Medical Park Dr, Spartanburg, SC 29303-4222 | 2006-04-03 |
1861475402 | Emory Levon Eastin | Obstetrics & Gynecology | 1686 Skylyn Dr, Suite 101, Spartanburg, SC 29307-1058 | 2005-11-29 |
1245700301 | Spartanburg Medical Center | Obstetrics & Gynecology | 1686 Skylyn Dr Ste 201, Spartanburg, SC 29307-1079 | 2018-12-03 |
1902243389 | Jessica Marie Hemsoth | Obstetrics & Gynecology | 853 N Church St Ste 700, Spartanburg, SC 29303-3003 | 2013-05-26 |
Find all providers in SPARTANBURG |
City | SPARTANBURG |
Zip Code | 29307 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.