Provider Demographics
NPI:1790917243
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:SENIOR VICE DEAN, FINANCE AND ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:B
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CPA
Authorized Official - Phone:215-777-5732
Mailing Address - Street 1:3223 N BROAD ST
Mailing Address - Street 2:SUITE 150
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140
Mailing Address - Country:US
Mailing Address - Phone:215-777-5808
Mailing Address - Fax:215-707-9486
Practice Address - Street 1:3223 N. BROAD STREET
Practice Address - Street 2:SUITE 150
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-5007
Practice Address - Country:US
Practice Address - Phone:215-238-6600
Practice Address - Fax:215-707-9486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE UNVIERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-08-18
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA033984Medicare PIN