MARY BLACK HEALTH SYSTEM, LLC


Address: 123 Dillon Dr, Spartanburg, SC 29307-1017
Phone: 8645858064

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
SC GP3445 05

Other Provider/Organization Names

Other Name Type Code
Kiesau Gynecology Associates Doing Business As Name - Organization

Other Provider IDs and Locations

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

Office Location

Street Address 123 DILLON DR
City SPARTANBURG
State SC
Zip Code 29307-1017

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 207V00000X
Grouping Allopathic & Osteopathic Physicians
Classification Obstetrics & Gynecology

Taxonomy Definition

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.

Providers in the same taxonomy and city

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

Competitor

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City SPARTANBURG
Zip Code 29307

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Dataset Information

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.

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