Basic Information
| Provider Information | |||||||||
| NPI: | 1740641414 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEMPLE PHYSICIANS INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | TEMPLE PRIMARY CARE AT JEANES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 820933 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2159269010 | ||||||||
| FaxNumber: | 2152268285 | ||||||||
| Practice Location | |||||||||
| Address1: | 7500 CENTRAL AVE | ||||||||
| Address2: | SUITE 107A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191112430 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153796444 | ||||||||
| FaxNumber: | 2153796220 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2016 | ||||||||
| LastUpdateDate: | 03/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | SAVERING | ||||||||
| AuthorizedOfficialFirstName: | LYNNIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2159269015 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TEMPLE PHYSICIANS INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 100727800 | 05 | PA | MEDICAID |