Provider Demographics
NPI:1790998375
Name:TEMPLE UNIVERSITY HOSPITAL
Entity Type:Organization
Organization Name:TEMPLE UNIVERSITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMIGO
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, MSN
Authorized Official - Phone:215-707-5914
Mailing Address - Street 1:3401 N BROAD ST
Mailing Address - Street 2:SUITE 752
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-5103
Mailing Address - Country:US
Mailing Address - Phone:215-707-5914
Mailing Address - Fax:
Practice Address - Street 1:61 JUSTICE DR
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1106
Practice Address - Country:US
Practice Address - Phone:215-579-6117
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP006435C261QA0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility