Provider Demographics
NPI:1194114322
Name:TEMPLE UNIVERSITY HOSPITAL, INC - FORT WASHINGTON
Entity type:Organization
Organization Name:TEMPLE UNIVERSITY HOSPITAL, INC - FORT WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:
Authorized Official - Last Name:OETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-707-3743
Mailing Address - Street 1:3401 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5103
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:515 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3314
Practice Address - Country:US
Practice Address - Phone:215-540-0120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE UNIVERSITY HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007351140008Medicaid
PA390027Medicare PIN