SELF MEDICAL GROUP NPI 1477880003

NPI Information

NPI: 1477880003
Provider Name: SELF MEDICAL GROUP
Classification: Clinic/Center - 261QR1300X
Specialization: Rural Health
Entity Type: Organization
Other Name: FAMILY HEALTHCARE NEWBERRY, A DIVISION OF SELF MEDICAL GROUP
CLIA Number: 42D0934930
Address: 2605 KINARD STREET
SUITE 200
NEWBERRY, SC
ZIP 29108
Phone: (803) 405-1900

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NPI Details

SELF MEDICAL GROUP is a rural health clinic center in Newberry, SC. SELF MEDICAL GROUP NPI is 1477880003. The provider is registered as an organization entity type and is a single specialty group.
The provider Other Name Is Family Healthcare Newberry, A Division Of Self Medical Group.

The provider's business location address is:

2605 KINARD STREET
SUITE 200
NEWBERRY, SC
ZIP 29108-967
Phone: (803) 405-1900
Fax: (803) 405-1919

The provider's authorized official is Matthew T Logan .
The authorized official title is President And Chief Executive Offic and has the following contact phone number (864) 725-4253.

The CLIA number assigned to this NPI record is 42D0934930 - physician office with a certificate type of Certificate for Provider-Performed Microscopy Procedures (PPMP).

The enumeration date for this NPI number is 11/3/2009 and was last updated on 12/14/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	207Q00000X	Family Medicine				No
2	261QR1300X	Clinic/Center	Rural Health	RHC208	SOUTH CAROLINA	Yes
3	261QR1300X	Clinic/Center	Rural Health			No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	GP5316	MEDICAID	SOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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