NPIMap

Organization Active NPI

Mary Black Health System, LLC

Doing business as Kiesau Gynecology Associates

  • Durable Medical Equipment & Medical Supplies
  • Spartanburg, SC
National Provider Identifier
1710995105
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
MARY BLACK HEALTH SYSTEM, LLC
Doing business as
Kiesau Gynecology Associates
Practice address
123 Dillon Dr
Spartanburg, SC 29307-1017
Phone
(864) 585-8064
NPI assigned
Aug 3, 2006
Last updated
Sep 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Rebecca Hurley
Title
Senior Vice President
Phone
(214) 473-3993

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X
Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VG0400X
Obstetrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207VX0000X
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

123 Dillon Dr
Spartanburg, SC 29307-1017

Mailing address

138 Dillon Dr Ste a
Spartanburg, SC 29307-1018
Phone (864) 542-8980

Other names 1

  • Kiesau Gynecology Associates Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Kevin P Tracy MD21 organizations share this tax ID, including this one

Other organizations with this tax ID 20

Organizations that report the same tax identification number in the National Provider Directory.

View all 20

Locations

123 Dillon Dr
Spartanburg, SC 29307
Phone (864) 573-9100

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1757548800000",
    "number": "1710995105",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "138 DILLON DR STE A",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071018",
            "telephone_number": "864-542-8980",
            "fax_number": "864-515-9994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 DILLON DR",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293071017",
            "telephone_number": "864-585-8064"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY BLACK HEALTH SYSTEM, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2025-09-11",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "SENIOR VICE PRESIDENT",
        "authorized_official_telephone_number": "214-473-3993"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VG0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207VX0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology, Obstetrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kiesau Gynecology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Spartanburg, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.