Provider Demographics
NPI:1154344422
Name:FIRST STATE FOOT & ANKLE, LLC
Entity type:Organization
Organization Name:FIRST STATE FOOT & ANKLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLVECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-984-0257
Mailing Address - Street 1:4512 KIRKWOOD HIGHWAY SUITE 203
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808
Mailing Address - Country:US
Mailing Address - Phone:302-984-0257
Mailing Address - Fax:302-984-0258
Practice Address - Street 1:4512 KIRKWOOD HIGHWAY SUITE 203
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808
Practice Address - Country:US
Practice Address - Phone:302-984-0257
Practice Address - Fax:302-984-0258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEE1-0000143213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE2245524000OtherAMERIHEALTH/ KEYSTONE #
DE7752539OtherAETNA GROUP #
DE1000027213Medicaid
DE0001047917OtherDELAWARE PHYSICIANS INC.
DE0001047917OtherDELAWARE PHYSICIANS INC.
DE1000027213Medicaid