MEDICARE: ST ANDREWS MEDICAL INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	16710	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144358425
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST ANDREWS MEDICAL INC

Provider Business Mailing Address
First Line	:	1249A SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7826
Country	:	US
Telephone Number	:	843-763-2000
Fax Number	:	843-763-2325

Provider Business Practice Location Address
First Line	:	1249A SAVANNAH HWY
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-7826
Country	:	US
Telephone Number	:	843-763-2000
Fax Number	:	843-763-2325

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RUTH DEHAVEN
Credential	:	MD
Telephone Number	:	843-763-2000

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	01/31/2008

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Directions to “ST ANDREWS MEDICAL INC ” Practice Location

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