FAMILY HEALTHCARE NINETY SIX, A DIVISION OF SELF MEDICAL GROUP - NPI 1609262807

Q: What is Self Medical Group's NPI number?

The NPI number for Self Medical Group is 1609262807. It was assigned to this organization in the NPPES registry on April 14, 2015. The provider is also known as Family Healthcare Ninety Six, A Division Of Self Medical Group.

Q: What is Self Medical Group's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

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About Family Healthcare Ninety Six, A Division Of Self Medical Group NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

FAMILY HEALTHCARE NINETY SIX, A DIVISION OF SELF MEDICAL GROUP (NPI 1609262807) is a healthcare organization registered as a family medicine in Ninety Six, South Carolina and active in the NPI registry since April 2015. The organization holds a CLIA Waiver certificate valid through August 31, 2027 and lists Matthew T Logan, President And Ceo, as its authorized official.

NPPES Registry Identity

NPI1609262807

Entity TypeOrganization

Primary Taxonomy207Q00000X

Legal Business NameSELF MEDICAL GROUP

Location Address103 LITTLE MOUNTAIN RDNinety Six, SC 29666-9252

Mailing Address103 Little Mountain RdNinety Six, SC 29666-9252 · (864) 543-3515

Phone(864) 543-3515

Organization SubpartNo

Authorized OfficialMatthew T LoganPresident And Ceo · (864) 725-4253

Enumeration DateApril 14, 2015

Last NPPES UpdateDecember 14, 2021

NPPES CertifiedDecember 14, 2021

✔ NPI 1609262807 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207Q00000X

Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

103 LITTLE MOUNTAIN RD, Ninety Six, SC 29666

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Other Names 1

Other NameFamily Healthcare Ninety Six, A Division Of Self Medical Group

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Absolute Total Care, Ambetter of North Carolina, First Choice Next and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 42D0253132

Family Healthcare - Ninety Six · Ninety Six, SC

Active · expires Aug 31, 2027

CLIA Number42D0253132

Laboratory TypePhysician Office

Certificate Effective DateSeptember 1, 2025

Certificate Expiration DateAugust 31, 2027

Laboratory DirectorReid Castellone

Laboratory Phone(864) 543-3515

Laboratory LocationFamily Healthcare - Ninety Six103 Little Mountain Road, Ninety Six, SC 29666

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 10

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. JENNIFER SMITH LINDLER LPC

Counselor (Professional)