Basic Information
| Provider Information | |||||||||
| NPI: | 1295125235 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TEMPLE PHYSICIANS INC | ||||||||
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| OtherOrganizationName: | TEMPLE PHYSICIANS AT SOMERTON | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12000 BUSTLETON AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191162151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156737600 | ||||||||
| FaxNumber: | 2156731894 | ||||||||
| Practice Location | |||||||||
| Address1: | 12000 BUSTLETON AVE | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191162151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2156737600 | ||||||||
| FaxNumber: | 2156731894 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2015 | ||||||||
| LastUpdateDate: | 01/29/2015 | ||||||||
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| AuthorizedOfficialLastName: | SAVERING | ||||||||
| AuthorizedOfficialFirstName: | LYNNIE | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR PATIENT ACCOUNTING | ||||||||
| AuthorizedOfficialTelephone: | 2159269015 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | TEMPLE PHYSICIANS INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1007278000 | 01 | PA | TPI MEDICAID GROUP | OTHER | CD4829 | 01 | PA | TPI RAILROAD MEDICARE GROUP | OTHER | 597586 | 01 | PA | TPI MEDICARE GROUP | OTHER |