Self Medical Group
Organization Active NPI Family Medicine Physician · Saluda, SC
NPI 1659815652 · NPPES record last updated Dec 14, 2021
Key facts
- NPI
- 1659815652
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SELF MEDICAL GROUP
- Practice address
- 102 R L Sawyer MD Dr
Saluda, SC 29138-9199 - Phone
- (864) 445-2173
- Fax
- (864) 445-9158
- NPI assigned
- Dec 9, 2016
- Organization subpart
- No
Authorized official
- Name
- Dr. Matthew T Logan, MD
- Title
- President and Ceo
- Phone
- (864) 725-4253
Practitioners 5
-
Anas Abdel Azim, M.D., M.SC
-
Jacob Lang, PA-C
-
David Gregory Malpass, M.D.
-
Carmen Brewington Ricketts, MSN, APRN, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20091027000071 | SC | Part B Supplier - Clinic/Group Practice | 6002953916 |
Receives reassigned benefits from 613 practitioners This NPI is an additional NPI on the enrollment Practice locations: Saluda, SC; Newberry, SC; Greenwood, SC; Abbeville, SC; Clinton, SC; Greenville, SC |
National Provider Directory
Locations
160 Academy Ave
Greenwood, SC 29646
Phone (864) 223-7809
3131 Newberry Hwy
Saluda, SC 29138
Phone (800) 898-3232
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
102 R L Sawyer MD Dr
Saluda, SC 29138-9199
Mailing address
102 R L Sawyer MD Dr
Saluda, SC 29138-9199
Phone (864) 445-2173
Other names
- Family Healthcare South Saluda, A Division of Self Medical Group
Other providers in Saluda, SC
- SC Department of Juvenile Justice
- SC Department of Juvenile Justice
- Self Medical Group
- Self Medical Group
- Self Medical Group
- Self Regional Healthcare
- Self Regional Healthcare
- Holly Riley Shealy
- Julie Porth Smith
- South Carolina CVS Pharmacy LLC
All providers in Saluda, SC · Family Medicine 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 Dec 14, 2021. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.