Basic Information
| Provider Information | |||||||||
| NPI: | 1013068345 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEMPLE PHYSICIANS INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | TEMPLE PHYSICIANS AT LIBERTY SQUARE-ADULT MEDICINE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1300 W LEHIGH AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191322760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152268800 | ||||||||
| FaxNumber: | 2152268819 | ||||||||
| Practice Location | |||||||||
| Address1: | 1300 W LEHIGH AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191322760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2152268800 | ||||||||
| FaxNumber: | 2152268819 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2007 | ||||||||
| LastUpdateDate: | 02/04/2016 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SAVERING | ||||||||
| AuthorizedOfficialFirstName: | LYNNIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2159269015 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TEMPLE PHYSICIANS INC. | ||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0756985001 | 01 | PA | IBC (KHPE & PC) | OTHER | 100727800 | 05 | PA | MEDICAID | CD4829 | 01 | PA | RRM | OTHER | 5780450 | 01 | PA | AETNA PPO | OTHER | 1573344 | 01 | PA | CIGNA CAP & PPO | OTHER | 1026966 | 01 | PA | KEYSTONE MERCY | OTHER | 1961897 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 03071 | 01 | PA | HEALTH PARTNERS SITE # | OTHER | 0511323 | 01 | PA | AETNA HMO | OTHER | 15343 | 01 | PA | ELDER HEALTH | OTHER |