Provider Demographics
NPI:1073840856
Name:SELF MEDICAL GROUP
Entity Type:Organization
Organization Name:SELF MEDICAL GROUP
Other - Org Name:HOSPITAL MEDICINE SPECIALISTS OF SELF MEDICAL GROUP
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT AND CHIEF EXECUTIVE OFFIC
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:T
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-725-4253
Mailing Address - Street 1:1325 SPRING STREET
Mailing Address - Street 2:SELF MEDICAL GROUP ATTN: HOSPITAL MEDICINE SPECIALISTS
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3860
Mailing Address - Country:US
Mailing Address - Phone:864-725-4272
Mailing Address - Fax:864-725-4452
Practice Address - Street 1:1325 SPRING STREET
Practice Address - Street 2:HOSPITAL MEDICINE SPECIALISTS OF SELF MEDICAL GROUP
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3860
Practice Address - Country:US
Practice Address - Phone:864-725-4272
Practice Address - Fax:864-725-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-16
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC9337Medicare PIN
9337Medicare PIN