1356417497 NPI number — TEMPLE UNIVERSITY CHILDREN'S MEDICAL CENTER

Table of content: (NPI 1356417497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356417497 NPI number — TEMPLE UNIVERSITY CHILDREN'S MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEMPLE UNIVERSITY CHILDREN'S MEDICAL CENTER
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:
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:
1356417497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3509 N BROAD ST
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:
19140-4105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3509 N BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19140-4105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-707-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUX
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
VP AND CFO
Authorized Official Telephone Number:
215-707-3802

Provider Taxonomy Codes

  • Taxonomy code: 282NC2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 393306 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0169638603 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1007287550001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1058480 . This is a "HORIZON NJ" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 11 . This is a "ELDERHEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 393306 . This is a "HEALTH AMERICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1007287550002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1058480 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1058482 . This is a "KEYSTONE MERCY SPU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1058481 . This is a "KEYSTONE MERCY EMERGENCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 393306 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: AETNA . This is a "1004908" identifier . This identifiers is of the category "OTHER".
  • Identifier: 001700 . This is a "IBC KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 393306 . This is a "PRIVATE HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: PO39817 . This is a "CHAMPUS TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19236 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 393306 . This is a "DEVON" identifier . This identifiers is of the category "OTHER".




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