Provider Demographics
NPI:1619240777
Name:SELF REGIONAL HEALTHCARE
Entity Type:Organization
Organization Name:SELF REGIONAL HEALTHCARE
Other - Org Name:ACADEMY MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-725-4253
Mailing Address - Street 1:155 ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3869
Mailing Address - Country:US
Mailing Address - Phone:864-725-4865
Mailing Address - Fax:
Practice Address - Street 1:155 ACADEMY AVE
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:SC
Practice Address - Zip Code:29646-3869
Practice Address - Country:US
Practice Address - Phone:864-725-4865
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SELF REGIONAL HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-20
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty