1013165778 NPI number — FIRST STATE ORTHOPAEDICS PA

Table of Contents

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:
Provider Other Organization Name Type Code:
6
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: 363A00000X ; 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" .

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".




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