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Contact Information

SELF MEDICAL GROUP
115 ACADEMY AVE
GREENWOOD, SC29646-3869
 Phone: 864-725-7272
 Fax: 864-725-5799
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Neurological Surgery

207T00000X 02 Physician/General Surgery
 

Durable Medical Equipment & Medical Supplies

332B00000X 54 Other Medical Supply Company
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Physical Medicine & Rehabilitation

208100000X 25 Physician/Physical Medicine and Rehabilitation
 

Surgical

363AS0400X 97 Physician Assistant
Indicates primary specialty

NPI Profile & details for SELF MEDICAL GROUP

NPI Number 1902277270
LBN Legal business name SELF MEDICAL GROUP
Authorized official MATTHEW LOGAN - (PRESIDENT AND CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 10/13/2015
Last updated 05/15/2026 - About 3 weeks ago
Identifiers
SC Medicaid DE3708
SC Medicaid GP7015
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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