MEDICARE: DEVINE CORPORATION

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	332BX2000X	Oxygen Equipment & Supplies (DME)	2-S-1175	OK

General Provider Information

NPI Number	:	1508047424
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEVINE CORPORATION

Provider Business Mailing Address
First Line	:	918 W BROADWAY ST
Second Line	:	STE B
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-2431
Country	:	US
Telephone Number	:	918-371-6997
Fax Number	:	918-371-6997

Provider Business Practice Location Address
First Line	:	918 W BROADWAY ST
Second Line	:	STE B
City	:	COLLINSVILLE
State	:	OK
Zip	:	74021-2431
Country	:	US
Telephone Number	:	918-371-6997
Fax Number	:	918-371-6997

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. RONALD D RICHARDSON
Credential	:
Telephone Number	:	918-371-6997

Provider Enumeration Date	:	11/19/2007
Last Update Date	:	04/11/2008

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Directions to “DEVINE CORPORATION ” Practice Location

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