NPIMap

Organization Active NPI

Self Medical Group

  • Occupational Medicine Clinic/Center
  • Greenwood, SC
National Provider Identifier
1760808083
Registry record updated Dec 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine Clinic/CenterTaxonomy code 261QX0100X
Legal business name
SELF MEDICAL GROUP
Practice address
450 Old Brickyard Rd
Greenwood, SC 29649-8681
Phone
(864) 725-7491
NPI assigned
Mar 11, 2014
Last updated
Dec 14, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 14, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Matthew T Logan, MD
Title
President and Ceo
Phone
(864) 725-4253

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Clinic/Center 261QX0100X NU Primary

Addresses

Primary practice location

450 Old Brickyard Rd
Greenwood, SC 29649-8681

Mailing address

104 Wells Ave
Greenwood, SC 29646-3837
Phone (864) 725-7491

Other names 1

  • Light and Life Wellness Clinic Other name

National Provider Directory

National Provider Directory
Tax ID family
Self Medical Group25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Locations

450 Old Brickyard Rd
Greenwood, SC 29649
Phone (864) 725-7491

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1394496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639440000000",
    "number": "1760808083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WELLS AVE",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463837",
            "telephone_number": "864-725-7491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 OLD BRICKYARD RD",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296498681",
            "telephone_number": "864-725-7491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SELF MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-11",
        "last_updated": "2021-12-14",
        "certification_date": "2021-12-14",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "864-725-4253",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QX0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Occupational Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Light and Life Wellness Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Light and Life Wellness Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Greenwood, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.