Provider Demographics
NPI:1750469763
Name:HAVEN HILLS MEDICAL CLINIC
Entity Type:Organization
Organization Name:HAVEN HILLS MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVENDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:VARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-785-7708
Mailing Address - Street 1:1611 LURLYN ROAD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901
Mailing Address - Country:US
Mailing Address - Phone:573-785-7708
Mailing Address - Fax:573-785-7700
Practice Address - Street 1:1611 LURLYN ROAD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901
Practice Address - Country:US
Practice Address - Phone:573-785-7708
Practice Address - Fax:573-785-7700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A10212Medicare UPIN