Provider Demographics
NPI:1093803603
Name:GAVEN, P.A.
Entity Type:Organization
Organization Name:GAVEN, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-722-0162
Mailing Address - Street 1:497 SAINT MICHAELS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-7250
Mailing Address - Country:US
Mailing Address - Phone:972-722-0162
Mailing Address - Fax:972-722-6216
Practice Address - Street 1:497 SAINT MICHAELS WAY
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-7250
Practice Address - Country:US
Practice Address - Phone:972-722-0162
Practice Address - Fax:972-722-6216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0949282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX48643200OtherDEPT OF LABOR
TX0084LHOtherBC BS OF TX
TX48643200OtherDEPT OF LABOR