Provider Demographics
NPI:1487694865
Name:DEVINE AND KENNEDY, LLC
Entity type:Organization
Organization Name:DEVINE AND KENNEDY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CYNDEE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-270-5454
Mailing Address - Street 1:PO BOX 93825
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44101-5825
Mailing Address - Country:US
Mailing Address - Phone:330-884-1596
Mailing Address - Fax:330-793-2829
Practice Address - Street 1:1450 S CANFIELD NILES ROAD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44515-2331
Practice Address - Country:US
Practice Address - Phone:330-792-7495
Practice Address - Fax:330-793-2829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2387546Medicaid
OH9324262Medicare ID - Type UnspecifiedGROUP # LOCATION #2
OH2387546Medicaid
CK6742Medicare PIN