Healthcare Provider Details

I. General information

NPI: 1144295882
Provider Name (Legal Business Name): WILLIAM G DEVINE M.D. PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 N ELM ST
HENDERSON KY
42420-2783
US

IV. Provider business mailing address

PO BOX 1079
HENDERSON KY
42419-1079
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-7700
  • Fax: 270-827-4966
Mailing address:
  • Phone: 270-827-0353
  • Fax: 270-827-4966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35368
License Number StateKY

VIII. Authorized Official

Name: WILLIAM G DEVINE
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 270-827-0353