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Organization
SELF MEDICAL GROUP
Active
Organization
SELF MEDICAL GROUP
Active
Other names
Advanced Vascular Associates A Division of Self Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW T LOGAN MD (PRESIDENT AND CFO)
(864) 725-4253
Entity
Organization
Contact information
Practice address
160 ACADEMY AVE, GREENWOOD, SC 29646-3808
(864) 223-8090
Mailing address
160 ACADEMY AVE, GREENWOOD, SC 29646-3808
(864) 223-8090
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
—
—
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
02/24/2016
Last updated
12/14/2021
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