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General NPI Number Information
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NPI Number | 1144295882
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Entity Type | Organization
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Legal Business Name | WILLIAM G DEVINE M.D. PSC
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Dates
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Enumeration Date | 02/17/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 1305 N ELM ST
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City | HENDERSON
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State | KY
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Zip | 42420-2783
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Country | US
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Telephone | 270-827-7700
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Fax | 270-827-4966
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Provider Business Mailing Address
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Address Line | PO BOX 1079
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City | HENDERSON
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State | KY
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Zip | 42419-1079
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Country | US
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Telephone | 270-827-0353
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Fax | 270-827-4966
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WILLIAM G DEVINE
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Credential | M.D.
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Telephone | 270-827-0353
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LC0200X
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Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
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License Number | 35368
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License Number State | KY
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