Provider Demographics
NPI:1568655108
Name:DEVINS CLINIC
Entity type:Organization
Organization Name:DEVINS CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEVINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-363-0787
Mailing Address - Street 1:5701 W 119TH ST
Mailing Address - Street 2:BLDG C, STE 220
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66209-3721
Mailing Address - Country:US
Mailing Address - Phone:816-363-0787
Mailing Address - Fax:816-363-5090
Practice Address - Street 1:5701 W 119TH ST
Practice Address - Street 2:BLDG C, STE 220
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66209-3721
Practice Address - Country:US
Practice Address - Phone:816-363-0787
Practice Address - Fax:816-363-5090
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEVINS CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-27
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0412912207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA970470CMedicare PIN