1013165778 NPI number — FIRST STATE ORTHOPAEDICS PA

Table of content: (NPI 1013165778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013165778 NPI number — FIRST STATE ORTHOPAEDICS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST STATE ORTHOPAEDICS PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORTHOPAEDIC ASSOCIATES OF SOUTHERN DELAWARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013165778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 EXECUTIVE DR STE 11
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19702-3358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-731-2888
Provider Business Mailing Address Fax Number:
302-731-7049

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1539 SAVANNAH RD STE 203
Provider Second Line Business Practice Location Address:
BAYVIEW MEDICAL CENTER
Provider Business Practice Location Address City Name:
LEWES
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19958-1674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-644-3980
Provider Business Practice Location Address Fax Number:
302-644-2804
Provider Enumeration Date:
09/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
AUKAMP
Authorized Official First Name:
ARLEEN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CREDENTIALING MANAGER
Authorized Official Telephone Number:
302-451-6913

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1030265 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "ONE NET PPO, MAMSI, OPTIMUM CHOICE, M.D. IPA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0848032000 . This is a "AMERIHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 51-0343207 . This is a "BLUE CROSS BLUE SHIELD OF DELAWARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "CORVEL/CORCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "GREAT WEST HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0000633502 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 510370286 . This is a "EASTERN SUSSEX PHYSICIANS ORGANIZATION, P.A." identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204885 . This is a "UNISON HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "DEVON HEALTH SERVICES" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "UNION LABOR LIFE INSURANCE COMPANY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 510370286 . This is a "HEALTH NET-TRICARE/CHAMPUS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com