SELF MEDICAL GROUP (NPI# 1871809855) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871809855 |
| Entity Type | Organization |
| Organization Name | SELF MEDICAL GROUP |
| Other Organization Name | UROLOGICAL SERVICES OF SELF MEDICAL GROUP |
| Practice Address |
109 Liner Dr Greenwood SC 29646-2311 |
| Practice Telephone | 8642276401 |
| Practice Fax Number | 8649414995 |
| Mailing Telephone | 8642276401 |
| Mailing Fax Number | 8649414995 |
| Enumeration Date | 2010-08-27 |
| Last Update Date | 2019-08-07 |
| NPI Deactivation Date | 05/22/2012 |
| NPI Reactivation Date | 2019-06-06 |
| Authorized Official Name | JAMES A PFEIFFER (PRESIDENT AND CEO) |
| Authorized Official Telephone | 8647254253 |
| Is Organization Subpart | Y |
| Parent Organization Name | SELF MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Advanced Urology a division of Self Medical Group | Other Name - Individual/Organization |
| Advanced Urology Associates, A Division of Self Medical Group | Other Name - Individual/Organization |
| Urological Services of Self Medical Group | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487212130 | Self Medical Group | Family Medicine | 105 Vinecrest Ct # 510, Greenwood, SC 29646-8031 | 2019-05-29 |
| 1750800264 | Self Medical Group | Family Medicine | 110 Highway 246 N, Greenwood, SC 29649-8748 | 2017-09-15 |
| 1760808083 | Self Medical Group | Clinic/Center | 450 Old Brickyard Rd, Greenwood, SC 29649-8681 | 2014-03-11 |
| 1588969448 | Self Medical Group | Nurse Practitioner | 104 Liner Drive, Greenwood, SC 29646 | 2011-01-24 |
| 1417252636 | Self Medical Group | Family Medicine | 138 Wells Avenue, Greenwood, SC 29646-3837 | 2011-01-19 |
| 1376843037 | Self Medical Group | Obstetrics & Gynecology | 107 Venture Court, Greenwood, SC 29649-8558 | 2010-10-28 |
| 1629382056 | Self Medical Group | Family Medicine | 207 Holiday Road, Mccormick, SC 29835-3430 | 2010-07-27 |
| 1942528161 | Self Medical Group | Family Medicine | 167 Greenwood Ave S, Ware Shoals, SC 29692 | 2010-05-12 |
| 1134442890 | Self Medical Group | Physician Assistant | 115 Academy Avenue, Unit A, Greenwood, SC 29646 | 2010-03-10 |
| 1457685570 | Self Medical Group | Surgery | 160 Academy Avenue, Greenwood, SC 29646-3808 | 2009-09-22 |
| Street Address |
109 LINER DR |
| City | GREENWOOD |
| State | SC |
| Zip Code | 29646-2311 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649273749 | Greenwood Urological P.a. | Urology | 109 Liner Dr, Greenwood, SC 29646-2311 | 2005-05-23 |
| 1245600956 | David Everett Feece | Physician Assistant | 109 Liner Dr, Greenwood, SC 29646-2311 | 2015-10-07 |
| 1003121989 | Arnold P Mulkey | Urology | 109 Liner Dr, Greenwood, SC 29646-2311 | 2010-08-16 |
| 1558483842 | Greenwood Urological Obs | Specialist | 109 Liner Dr, Greenwood, SC 29646-2311 | 2007-04-06 |
| 1568456226 | William Preston Turner IIi | Urology | 109 Liner Dr, Greenwood, SC 29646-2311 | 2005-09-08 |
| 1255325122 | Herman W. Parramore IIi | Urology | 109 Liner Dr, Greenwood, SC 29646-2311 | 2005-09-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114535416 | Supriya Lal | Dietitian, Registered | 303 Parkwood Rd, Greenwood, SC 29646 | 2020-07-22 |
| 1174158406 | Mara L Schwartz | Registered Nurse | 1226 Spring St., Diabtes Education Department, Greenwood, SC 29646 | 2020-03-06 |
| 1487213724 | Greater Greenwood United Ministry | Family Medicine | 1404 Edgefield Street, Greenwood, SC 29646 | 2019-06-11 |
| 1346747995 | Kelli Diane Clune | Nurse Practitioner | 115 E Alexander Ave, Greenwood, SC 29646 | 2018-04-10 |
| 1184150112 | Sanquinette Sanders Brownlee | Nurse Practitioner | 929 Phoenix Stret, Clinica Gratis, Greenwood, SC 29646 | 2017-05-11 |
| 1194258426 | Kimberley Lovejoy | Assistant Behavior Analyst | 210a Birchtree, Greenwood, SC 29646 | 2017-04-04 |
| 1427590900 | Rejuvenation Massage By Frances | Clinic/Center | 610 Chace Avenue, Greenwood, SC 29646 | 2016-11-15 |
| 1932651643 | Hayley Smith | Counselor | 110 Court Ave W, Greenwood, SC 29646 | 2016-10-28 |
| 1942757927 | Towanda Morton | Community Health Worker | 303 Suite B South Main Street, Greenwood, SC 29646 | 2016-09-07 |
| 1770039976 | Bragan Mace | Pharmacist | 1376 South Main St., Greenwood, SC 29646 | 2016-08-28 |
| Find all providers in zip 29646 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407848690 | James S Robbins IIi | Urology | 205 8th St, Greenwood, MS 38930-4011 | 2005-08-16 |
| 1649273749 | Greenwood Urological P.a. | Urology | 109 Liner Dr, Greenwood, SC 29646-2311 | 2005-05-23 |
| 1104228972 | Greenwood Leflore Hospital | Urology | 205 8th St, Greenwood, MS 38930 | 2014-09-23 |
| 1295145159 | Brian Orr | Urology | 679 E County Line Rd, Greenwood, IN 46143-1049 | 2014-04-30 |
| 1033462239 | Jason Ronald Kovac | Urology | 679 E County Line Rd, Greenwood, IN 46143-1049 | 2012-10-25 |
| 1861763260 | Greenwood Leflore Hosptial | Urology | 205 8th St, Greenwood, MS 38930-4011 | 2012-01-18 |
| 1003121989 | Arnold P Mulkey | Urology | 109 Liner Dr, Greenwood, SC 29646-2311 | 2010-08-16 |
| 1871736595 | James Harrison Raybourn IIi | Urology | 679 E County Line Rd, Greenwood, IN 46143-1049 | 2009-04-10 |
| 1871750455 | David A Gilley | Urology | 679 E County Line Rd, Greenwood, IN 46143-1049 | 2008-05-21 |
| 1124033550 | Samuel T Thompson | Urology | 679 E County Line Rd, Greenwood, IN 46143-1049 | 2006-07-31 |
| Find all providers in GREENWOOD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.