1174783203 NPI number — TEMPLE PHYSICIANS INC

Table of content: (NPI 1174783203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174783203 NPI number — TEMPLE PHYSICIANS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEMPLE PHYSICIANS INC
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:
WOMEN'S CARE AT HUNTING PARK
Provider Other Organization Name Type Code:
5
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:
1174783203
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 820933
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19182-0933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-926-9010
Provider Business Mailing Address Fax Number:
215-226-8285

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
133 W HUNTING PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 300-C
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140-2717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-291-3700
Provider Business Practice Location Address Fax Number:
215-291-3703
Provider Enumeration Date:
06/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LYNNIE
Authorized Official First Name:
SAVERING
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
215-926-9050

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1913147 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1913147 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007278000110 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1121595 . This is a "KEYSTONE MERCY HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2056273 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0438334023 . This is a "IBC (KHPE & PC)" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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