MEDICARE: DR. STEPHEN E BOATWRIGHT MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	12340	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	:	1538157334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN E BOATWRIGHT MD

Provider Business Mailing Address
First Line	:	3926 WESLEY ST
Second Line	:	SUITE 502
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-7332
Country	:	US
Telephone Number	:	843-353-1596
Fax Number	:	843-236-5088

Provider Business Practice Location Address
First Line	:	4736 HIGHWAY 17 BYP S
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-5616
Country	:	US
Telephone Number	:	843-231-2039
Fax Number	:	843-293-2454

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	08/22/2016

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