Basic Information
| Provider Information | |||||||||
| NPI: | 1144261579 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TEMPLE PHYSICIANS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 820956 | ||||||||
| Address2: | TEMPLE PHYSICIANS INC | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191820956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8007772455 | ||||||||
| FaxNumber: | 6106176280 | ||||||||
| Practice Location | |||||||||
| Address1: | 2301 E ALLEGHENY AVENUE | ||||||||
| Address2: | NORTHEASTERN HOSPITAL | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2154232376 | ||||||||
| FaxNumber: | 2156344872 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/09/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | MANKIN | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2157824000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | PA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1007278000063 | 05 | PA | MEDICAID | 0812055000 | 01 | PA | INDEPENDENCE BLUE CROSS | OTHER |