Provider Demographics
NPI:1063625366
Name:TEMPLE PHYSICIAN INC.
Entity type:Organization
Organization Name:TEMPLE PHYSICIAN INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAVERING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-926-9015
Mailing Address - Street 1:PO BOX 820933
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0933
Mailing Address - Country:US
Mailing Address - Phone:215-926-9000
Mailing Address - Fax:215-226-8285
Practice Address - Street 1:1600 LONEY ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19111-2935
Practice Address - Country:US
Practice Address - Phone:215-742-1166
Practice Address - Fax:215-745-1333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE PHYSICIANS INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-07
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007278000069Medicaid
PA0756985076OtherIBC (KHPE & PC)
PA30041229OtherKEYSTONE MERCY
PA1961930OtherHIGHMARK BLUE SHIELD
PA1007278000069Medicaid
PA30041229OtherKEYSTONE MERCY