Basic Information
| Provider Information | |||||||||
| NPI: | 1568444529 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ANDREWS | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | FRANCIS | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | MANAGED CARE DEPT | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 4708 OLEANDER DR | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295775742 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8434499415 | ||||||||
| FaxNumber: | 8434492160 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2005 | ||||||||
| LastUpdateDate: | 11/21/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 05011096L | PA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | DO949 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 5902818 | 05 | SC | MEDICAID | 774037 | 01 | SC | WELLCARE | OTHER | 80023851 | 01 | SC | SELECT HEALTH | OTHER | 5902818 | 05 | NC | MEDICAID | 9857551 | 01 | SC | CIGNA | OTHER | 009494 | 05 | SC | MEDICAID | 20089407 | 01 | SC | SELECT HEALTH OF SOUTH CAROLINA | OTHER | 9834674 | 01 | SC | AETNA | OTHER |