Provider Demographics
NPI:1164077525
Name:BATESVILLE MEDICAL CLINIC, LLC
Entity Type:Organization
Organization Name:BATESVILLE MEDICAL CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:662-563-6000
Mailing Address - Street 1:107 EUREKA ST STE A
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-2533
Mailing Address - Country:US
Mailing Address - Phone:662-563-6000
Mailing Address - Fax:662-563-2200
Practice Address - Street 1:107 EUREKA ST STE A
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-2533
Practice Address - Country:US
Practice Address - Phone:662-563-6000
Practice Address - Fax:662-563-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-02
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty