Organization
GAVINI MEDICAL GROUP,LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA ANNETTE HAWKINS RMA (OFFICE MANAGER)
(314) 822-7033
Entity
Organization
Contact information
Practice address
10000 WATSON RD, 2L-24, SAINT LOUIS, MO 63126-1854
(314) 822-7033
(314) 822-3666
Mailing address
10000 WATSON RD, 2L-24, SAINT LOUIS, MO 63126-1854
(314) 822-7033
(314) 822-3666
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
R6940
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
011155588
RAILROAD MEDICARE
MO
01
—
17766
BC/BS SHIELD OF MO
MO
05
—
501758304
—
MO
01
—
997
FEDERAL BC/BS OF MO
MO
Enumeration date
08/25/2006
Last updated
09/23/2008
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