Provider Demographics
NPI:1316031511
Name:HAVENS MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:HAVENS MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:REEVES
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-283-4441
Mailing Address - Street 1:207 SPARKS AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47130-3739
Mailing Address - Country:US
Mailing Address - Phone:812-283-4441
Mailing Address - Fax:812-288-2605
Practice Address - Street 1:207 SPARKS AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:JEFFERSONVILLE
Practice Address - State:IN
Practice Address - Zip Code:47130-3739
Practice Address - Country:US
Practice Address - Phone:812-283-4441
Practice Address - Fax:812-288-2605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100074620AMedicaid
IN121630Medicare ID - Type Unspecified