MEDICARE: GAVINI MEDICAL GROUP,LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	R6940	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	011155588	OTHER	MO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	997	OTHER	MO	FEDERAL BC/BS OF MO
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	17766	OTHER	MO	BC/BS SHIELD OF MO

General Provider Information

NPI Number	:	1912014606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GAVINI MEDICAL GROUP,LTD

Provider Business Mailing Address
First Line	:	10000 WATSON RD
Second Line	:	2L-24
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-1854
Country	:	US
Telephone Number	:	314-822-7033
Fax Number	:	314-822-3666

Provider Business Practice Location Address
First Line	:	10000 WATSON RD
Second Line	:	2L-24
City	:	SAINT LOUIS
State	:	MO
Zip	:	63126-1854
Country	:	US
Telephone Number	:	314-822-7033
Fax Number	:	314-822-3666

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. LAURA ANNETTE HAWKINS
Credential	:	RMA
Telephone Number	:	314-822-7033

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	09/23/2008

Similar Medicare Providers

1215926209 — MS. DENISE L KIMACK DMD
Practice Location Address:

10000 WATSON RD , STE D
SAINT LOUIS, MO
63126-1854

Practice Phone: 314-821-3191
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1215919246 — DR. BRIAN R OGLANDER D.M.D.
Practice Location Address:

10000 WATSON RD , SUITE A
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1801878541 — DR. ANTHONY KRAMER
Practice Location Address:

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63126-1854

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1255448114 — DR. RICHARD WILLIAM NORLIN D.P.M.
Practice Location Address:

10000 WATSON RD , SUITE 1B
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1922117647 — GERARDA THERESA WEIS LCSW
Practice Location Address:

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1689779118 — RAVI MEHRA MD, P.C.
Practice Location Address:

10000 WATSON RD , STE 2-L-13
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Directions to “GAVINI MEDICAL GROUP,LTD ” Practice Location

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