Self Regional Healthcare
Organization Active NPI Obstetrics & Gynecology Physician · Greenwood, SC
NPI 1225838733 · NPPES record last updated Mar 14, 2025
Key facts
- NPI
- 1225838733
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Obstetrics & Gynecology Physician 207V00000X
- Legal business name
- SELF REGIONAL HEALTHCARE
- Practice address
- 106 Liner Dr
Greenwood, SC 29646-2310 - Phone
- (864) 227-6371
- Fax
- (864) 227-6345
- NPI assigned
- Mar 14, 2025
- Organization subpart
- No
Authorized official
- Name
- Matthew Tolbert Logan
- Title
- President & Ceo
- Phone
- (864) 725-4780
Other NPIs on the same Medicare enrollment 27
Corporate family (same tax ID) 46
Practitioners 11
-
Douglas M Addy, MD
-
Amy Vines Fletcher, FNP
-
Amanda Lee Holsopple, M.D.
-
John Howard Nordeen, M.D.
-
Stephanie Hunter Schafer, FNP-C, IBCLC
-
Emma Louise White, D.O.
-
Rebecca Anne Keith, M.D.
-
Michael S Liao, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 42D0252971 | Advanced Obstetrics and Gynecology | Provider-performed microscopy | Aug 31, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051214000767 | SC | Part B Supplier - Clinic/Group Practice | 4082527742 |
Receives reassigned benefits from 234 practitioners 27 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Greenwood, SC; Clinton, SC; Ware Shoals, SC; Saluda, SC; Ninety Six, SC; Newberry, SC; MC Cormick, SC; Laurens, SC… |
National Provider Directory
- Tax ID family
- Western Carolina Psych
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Obstetrics & Gynecology Physician |
207V00000X | Yes | ||
| Gynecology Physician |
207VG0400X |
Addresses
Primary practice location
106 Liner Dr
Greenwood, SC 29646-2310
Mailing address
104 Wells Ave
Greenwood, SC 29646-3837
Phone (864) 725-4673
Other names
- Advanced Obstetrics and Gynecology
Other providers in Greenwood, SC
- Self Regional Healthcare
- Self Regional Healthcare
- Self Regional Healthcare
- Self Regional Healthcare
- Self Regional Healthcare
- Self Regional Healthcare
- Self Regional Healthcare
- Self Regional Healthcare
- Self Regional Healthcare
- Self Regional Healthcare
All providers in Greenwood, SC · Obstetrics & Gynecology Physician in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 14, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.