Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Johnny Leo Divine

Individual provider Customized Equipment (DME) · NPI 1275092991

Johnny Leo Divine is a Customized Equipment (DME) in Golden City, Missouri. Practices as a sole proprietor. Registered with an NPI since 2019.

In the registry since
2019
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Practice location Address checks out

507 Main St
Golden City, MO 64748
Phone: (417) 262-2524
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Customized Equipment (DME) (primary) Taxonomy 332BC3200X

Record details

NPI number1275092991
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedMarch 13, 2019
Last updated in NPPESMarch 13, 2019