Provider Demographics
NPI:1023224730
Name:FIRST STATE PHYSICIANS, INC.
Entity type:Organization
Organization Name:FIRST STATE PHYSICIANS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:302-836-6150
Mailing Address - Street 1:12 FOX HUNT DR
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2534
Mailing Address - Country:US
Mailing Address - Phone:302-836-6150
Mailing Address - Fax:302-836-6294
Practice Address - Street 1:12 FOX HUNT DR
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2534
Practice Address - Country:US
Practice Address - Phone:302-836-6150
Practice Address - Fax:302-836-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE2002101782111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEU97391Medicare UPIN
DEG01338F01Medicare ID - Type Unspecified