Organization
SELF MEDICAL GROUP
Active
Organization
SELF MEDICAL GROUP
Active
Other names
Family Healthcare Newberry, A Division of Self Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MATTHEW T LOGAN MD (PRESIDENT AND CHIEF EXECUTIVE OFFIC)
(864) 725-4253
Entity
Organization
Contact information
Practice address
2605 KINARD STREET, SUITE 200, NEWBERRY, SC 29108-2967
(803) 405-1900
(803) 405-1919
Mailing address
2605 KINARD STREET, SUITE 200, NEWBERRY, SC 29108-2967
(803) 405-1900
(803) 405-1919
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
RHC208
SC
261QR1300X
Rural Health Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GP5316
—
SC
Enumeration date
11/03/2009
Last updated
12/14/2021
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