# SELF MEDICAL GROUP

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Urological Services of Self Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1871809855
- **Authorized official:** DR. MATTHEW T LOGAN MD (PRESIDENT AND CEO)
- **Authorized official phone:** (864) 725-4253

## Contact information

- **Practice address:** 109 LINER DR, GREENWOOD, SC 29646-2311
- **Practice address phone:** (864) 227-6401
- **Practice address fax:** (864) 941-4995
- **Mailing address:** 109 LINER DR, GREENWOOD, SC 29646-2311
- **Mailing address phone:** (864) 227-6401
- **Mailing address fax:** (864) 941-4995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |

## Other

- **Enumeration date:** 08/27/2010
- **Last updated:** 12/14/2021