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General NPI Number Information
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NPI Number | 1184219214
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Entity Type | Organization
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Legal Business Name | SELF MEDICAL GROUP
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 10/20/2023
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Provider Practice Location Address
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Address Line | 3165 NEWBERRY HWY
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City | SALUDA
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State | SC
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Zip | 29138-0198
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Country | US
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Telephone | 864-445-2500
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Fax | 864-445-3956
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Provider Business Mailing Address
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Address Line | 3165 NEWBERRY HWY
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City | SALUDA
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State | SC
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Zip | 29138-0198
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Country | US
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Telephone | 864-445-2500
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Fax | 864-445-3956
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. MATTHEW T LOGAN
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Credential | MD
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Telephone | 864-725-4253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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