Basic Information
| Provider Information | |||||||||
| NPI: | 1013068899 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEMPLE PHYSICIANS INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | TPI FAMILY MEDICINE LEHIGH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 820933 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159269010 | ||||||||
| FaxNumber: | 2152268285 | ||||||||
| Practice Location | |||||||||
| Address1: | 412 W LEHIGH AVE # 22 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191333148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154250124 | ||||||||
| FaxNumber: | 2154255786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2007 | ||||||||
| LastUpdateDate: | 03/04/2008 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SAVERING | ||||||||
| AuthorizedOfficialFirstName: | LYNNIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2159269019 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TEMPLE PHYSICIANS INC. | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0476622 | 01 | PA | AETNA HMO | OTHER | 0756985051 | 01 | PA | IBC (KHPE & PC) | OTHER | 15384 | 01 | PA | ELDER HEALTH | OTHER | 1007278000093 | 05 | PA | MEDICAID | 10108 | 01 | PA | HEALTH PARTNERS SITE # | OTHER | 5761619 | 01 | PA | AETNA PPO | OTHER | 1005207 | 01 | PA | KEYSTONE MERCY | OTHER | 1961905 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER |