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General NPI Number Information
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NPI Number | 1093803603
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Entity Type | Organization
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Legal Business Name | GAVEN, P.A.
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 11/09/2007
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Provider Practice Location Address
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Address Line | 497 SAINT MICHAELS WAY
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City | ROCKWALL
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State | TX
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Zip | 75032-7250
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Country | US
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Telephone | 972-722-0162
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Fax | 972-722-6216
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Provider Business Mailing Address
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Address Line | 497 SAINT MICHAELS WAY
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City | ROCKWALL
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State | TX
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Zip | 75032-7250
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Country | US
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Telephone | 972-722-0162
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Fax | 972-722-6216
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Authorized Official
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Title or Position | PRESIDENT
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Name | STEVEN HOWARD THOMPSON
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Credential | M.D.
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Telephone | 972-722-0162
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | L0949
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License Number State | TX
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