| Dr Myrna Ivelisse Gover Havener, MD | |
|
1780 Old Highway 50 E, Union, MO 63084 | |
| (888) 403-1071 | |
| Not Available |
| Full Name | Dr Myrna Ivelisse Gover Havener |
|---|---|
| Gender | Female |
| Speciality | Internal Medicine |
| Location | 1780 Old Highway 50 E, Union, Missouri |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487664942 | NPI | - | NPPES |
| 2010036458 | Other | MO | MISSOURI STATE BOARD OF REGISTRATION |
| 145265801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 2010036458 (Missouri) | Primary |
| Entity Name | Physician Groups Lc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1285664268 PECOS PAC ID: 3072421254 Enrollment ID: O20040220001157 |
| Entity Name | Sound Physicians Of Illinois Llc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1043598865 PECOS PAC ID: 1557533734 Enrollment ID: O20170519000666 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Myrna Ivelisse Gover Havener, MD 660 Mason Ridge Center Dr Ste 300, Saint Louis, MO 63141-8512 Ph: (314) 448-3791 | Dr Myrna Ivelisse Gover Havener, MD 1780 Old Highway 50 E, Union, MO 63084 Ph: (888) 403-1071 |
Shaukat A Thanawalla, M.D. Internal Medicine Medicare: Accepting Medicare Assignments Practice Location: 97 Saint Andrews Dr, Union, MO 63084 Phone: 636-583-2946 Fax: 636-583-6131 | |
Dr. Joi C Irving, M.D. Internal Medicine Medicare: Medicare Enrolled Practice Location: 1935 Prairie Dell Rd Ste 400, Union, MO 63084 Phone: 636-583-2508 | |
Dr. Stephanie Diane Bauerle, D.O. Internal Medicine Medicare: Not Enrolled in Medicare Practice Location: 1780 Old Us Highway 50 E, Suite 115, Union, MO 63084 Phone: 636-583-8555 Fax: 636-583-8559 |