Provider Demographics
NPI:1508047424
Name:DEVINE CORPORATION
Entity Type:Organization
Organization Name:DEVINE CORPORATION
Other - Org Name:DEVINE HEALTHCARE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:D
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-371-6997
Mailing Address - Street 1:918 W BROADWAY ST
Mailing Address - Street 2:STE B
Mailing Address - City:COLLINSVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74021-2431
Mailing Address - Country:US
Mailing Address - Phone:918-371-6997
Mailing Address - Fax:918-371-6997
Practice Address - Street 1:918 W BROADWAY ST
Practice Address - Street 2:STE B
Practice Address - City:COLLINSVILLE
Practice Address - State:OK
Practice Address - Zip Code:74021-2431
Practice Address - Country:US
Practice Address - Phone:918-371-6997
Practice Address - Fax:918-371-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-19
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2-S-1175332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5703300001Medicare NSC