Self Medical Group
Organization Active NPI Family Medicine Physician · Ware Shoals, SC
NPI 1942528161 · NPPES record last updated Dec 14, 2021
Key facts
- NPI
- 1942528161
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- SELF MEDICAL GROUP
- Practice address
- 167 Greenwood Ave S
Ware Shoals, SC 29692 - Phone
- (864) 456-3447
- Fax
- (864) 725-4979
- NPI assigned
- May 12, 2010
- Organization subpart
- No
Authorized official
- Name
- Dr. Matthew T Logan, MD
- Title
- President and Chief Executive Offic
- Phone
- (864) 725-4253
Practitioners 2
-
Kelly A. Gallagher-Kiley, LCSW
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
1033 Edgefield St
Greenwood, SC 29646
Phone (864) 227-3908
105 Vinecrest Ct
Ste 510
Greenwood, SC 29646
157 S Greenwood Ave
Ware Shoals, SC 29692
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
167 Greenwood Ave S
Ware Shoals, SC 29692
Mailing address
167 Greenwood Ave S
Ware Shoals, SC 29692
Phone (864) 456-3447
Other names
- Family Healthcare Ware Shoals a division of Self Medical Group
Other providers in Ware Shoals, SC
- Kimberly R McClain
- Park Pharmacy, Inc
- Park Pharmacy, Inc
- Joseph Seth Pulley
- Alison M Richter
- Self Regional Healthcare
- Self Regional Healthcare
- Ware Shoals School District 51
- West End Drug Inc
- Charles Eugene Willard
All providers in Ware Shoals, 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.