Provider Demographics
NPI:1447059837
Name:SELF REGIONAL HEALTHCARE
Entity type:Organization
Organization Name:SELF REGIONAL HEALTHCARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:TOLBERT
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-725-4780
Mailing Address - Street 1:104 WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-3837
Mailing Address - Country:US
Mailing Address - Phone:864-725-4673
Mailing Address - Fax:864-725-7424
Practice Address - Street 1:207 HOLIDAY RD
Practice Address - Street 2:
Practice Address - City:MC CORMICK
Practice Address - State:SC
Practice Address - Zip Code:29835-3430
Practice Address - Country:US
Practice Address - Phone:864-391-5011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health