Provider Demographics
NPI:1346608049
Name:JOVEN MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:JOVEN MEDICAL GROUP LLC
Other - Org Name:JOHN N. JOVEN, M.D.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:N
Authorized Official - Last Name:JOVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-498-1491
Mailing Address - Street 1:PO BOX 161
Mailing Address - Street 2:
Mailing Address - City:FORTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46040-0161
Mailing Address - Country:US
Mailing Address - Phone:317-586-3612
Mailing Address - Fax:
Practice Address - Street 1:745 N SWOPE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1332
Practice Address - Country:US
Practice Address - Phone:317-498-1491
Practice Address - Fax:317-326-8333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01045421207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INBJ5085786OtherCONTROLLED SUBSTANCE REGISTRATION
IN01045421OtherINDIANA MEDICAL LICENSE
INBJ5085786OtherCONTROLLED SUBSTANCE REGISTRATION