MEDICARE: DR. DEVON MCILVAINE-SPRINGER AU.D.

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	231H00000X	Audiologist	A.01802	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003164914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEVON MCILVAINE-SPRINGER AU.D.

Provider Business Mailing Address
First Line	:	2667 QUARRY VALLEY RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-4972
Country	:	US
Telephone Number	:	330-277-1381
Fax Number	:

Provider Business Practice Location Address
First Line	:	2667 QUARRY VALLEY RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-4972
Country	:	US
Telephone Number	:	330-277-1381
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	09/19/2019

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