Healthcare Provider Details

I. General information

NPI: 1619990884
Provider Name (Legal Business Name): SELF REGIONAL PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22580 HIGHWAY 76 E SUITE 100
LAURENS SC
29360-8439
US

IV. Provider business mailing address

PO BOX 30
CLINTON SC
29325
US

V. Phone/Fax

Practice location:
  • Phone: 864-833-5986
  • Fax: 864-833-0599
Mailing address:
  • Phone: 864-833-5986
  • Fax: 864-833-0599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES PFEIFFER
Title or Position: PRESIDENT AND CEO
Credential:
Phone: 864-725-4253