Provider Demographics
NPI:1043487366
Name:TEMPLE UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:TEMPLE UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER COGENT HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPMSM
Authorized Official - Phone:615-377-5670
Mailing Address - Street 1:1316 W ONTARIO ST
Mailing Address - Street 2:JONES HALL 9TH FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5220
Mailing Address - Country:US
Mailing Address - Phone:215-707-9403
Mailing Address - Fax:215-225-1698
Practice Address - Street 1:1316 W ONTARIO ST
Practice Address - Street 2:JONES HALL 9TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5220
Practice Address - Country:US
Practice Address - Phone:215-707-9403
Practice Address - Fax:215-225-1698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433919282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital