# SELF REGIONAL HEALTHCARE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Pediatric Associates Greenwood
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225838832
- **Authorized official:** MATTHEW TOLBERT LOGAN (PRESIDENT & CEO)
- **Authorized official phone:** (864) 725-4780

## Contact information

- **Practice address:** 210 WELLS AVE, GREENWOOD, SC 29646-3843
- **Practice address phone:** (864) 943-4279
- **Practice address fax:** (864) 223-2642
- **Mailing address:** 104 WELLS AVE, GREENWOOD, SC 29646-3837
- **Mailing address phone:** (864) 725-4673
- **Mailing address fax:** (864) 725-7424

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | NULL | Yes |
| 208000000X | Pediatrics Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/14/2025
- **Last updated:** 03/14/2025