Healthcare Provider Details

I. General information

NPI: 1073486494
Provider Name (Legal Business Name): SELF REGIONAL HEALTHCARE PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 RIDGE MEDICAL PLAZA RD
EDGEFIELD SC
29824-4525
US

IV. Provider business mailing address

300 RIDGE MEDICAL PLAZA RD
EDGEFIELD SC
29824-4525
US

V. Phone/Fax

Practice location:
  • Phone: 803-384-4140
  • Fax: 803-384-4141
Mailing address:
  • Phone: 803-384-4140
  • Fax: 803-384-4141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW TOLBERT LOGAN
Title or Position: PRESIDENT & CEO
Credential:
Phone: 864-725-4780