Provider Demographics
NPI:1265446983
Name:TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Entity Type:Organization
Organization Name:TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Other - Org Name:TEMPLE FOOT AND ANKLE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR VICE DEAN
Authorized Official - Prefix:MR
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-777-5732
Mailing Address - Street 1:148 NORTH 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-7282
Mailing Address - Country:US
Mailing Address - Phone:215-777-5808
Mailing Address - Fax:215-777-5825
Practice Address - Street 1:148 N 8TH ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-2418
Practice Address - Country:US
Practice Address - Phone:215-777-5808
Practice Address - Fax:215-777-5825
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-28
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
213E00000X, 213E00000X
PA213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0055414000OtherKHPE
31299OtherAETNA US HEALTH CARE
PA31776OtherKMHP
PA1007780130840Medicaid
1818530OtherUNITED HEALTH CARE
PA435444OtherHEALTH AMERICA HEALTH ASSURANCE
PA1007780130286Medicaid
DA9675OtherTRAVELERS RR MEDICARE
28824OtherHEALTH PARTNERS
PATE338806OtherBS
PA435444OtherHEALTH AMERICA HEALTH ASS
PA435444OtherHEALTH AMERICA HEALTH ASS
DA9675OtherTRAVELERS RR MEDICARE
PA0055414000OtherKHPE