Provider Demographics
NPI:1144295882
Name:WILLIAM G DEVINE M.D. PSC
Entity type:Organization
Organization Name:WILLIAM G DEVINE M.D. PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:G
Authorized Official - Last Name:DEVINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-827-0353
Mailing Address - Street 1:PO BOX 1079
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42419-1079
Mailing Address - Country:US
Mailing Address - Phone:270-827-0353
Mailing Address - Fax:270-827-4966
Practice Address - Street 1:1305 N ELM ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2783
Practice Address - Country:US
Practice Address - Phone:270-827-7700
Practice Address - Fax:270-827-4966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35368207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64003551Medicaid
KY000000325047OtherANTHEM BC & BS
KY64003551Medicaid
KY000000325047OtherANTHEM BC & BS