SELF MEDICAL GROUP NPI 1760808083

NPI Information

  • NPI: 1760808083
  • Provider Name: SELF MEDICAL GROUP
  • Classification: Clinic/Center - 261QX0100X
  • Specialization: Occupational Medicine
  • Entity Type: Organization
  • Other Name: LIGHT AND LIFE WELLNESS CLINIC
  • Address: 450 OLD BRICKYARD RD
    GREENWOOD, SC
    ZIP 29649
  • Phone: (864) 725-7491

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NPI Details

SELF MEDICAL GROUP is an occupational medicine clinic center in Greenwood, SC. SELF MEDICAL GROUP NPI is 1760808083. The provider is registered as an organization entity type.
The provider Other Name Is Light And Life Wellness Clinic.

The provider's business location address is:

450 OLD BRICKYARD RD
GREENWOOD, SC
ZIP 29649-681
Phone: (864) 725-7491

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

The enumeration date for this NPI number is 3/11/2014 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
1261QX0100XClinic/CenterOccupational MedicineYes

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: 11/21/2025

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