Healthcare Provider Details

I. General information

NPI: 1316031511
Provider Name (Legal Business Name): HAVENS MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 SPARKS AVENUE SUITE 200
JEFFERSONVILLE IN
47130-3739
US

IV. Provider business mailing address

207 SPARKS AVENUE SUITE 200
JEFFERSONVILLE IN
47130-3739
US

V. Phone/Fax

Practice location:
  • Phone: 812-283-4441
  • Fax: 812-288-2605
Mailing address:
  • Phone: 812-283-4441
  • Fax: 812-288-2605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN REEVES HAVENS
Title or Position: PARTNER PHYSICIAN
Credential: MD
Phone: 812-283-4441