Provider Demographics
NPI:1265586580
Name:TEMPLE UNIVERSITY CHILDRENS MEDICAL CENTER
Entity type:Organization
Organization Name:TEMPLE UNIVERSITY CHILDRENS MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-707-3802
Mailing Address - Street 1:3509 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-4105
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3509 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140-4105
Practice Address - Country:US
Practice Address - Phone:215-707-5303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE UNIVERSITY CHILDRENS MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101901261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1058480OtherHORIZON NJ
PA1058481OtherKEYSTONE MERCY OUTPT
393306OtherUNITED HEALTHCARE
1004908OtherAETNA USHC
PA1007287550001Medicaid
PA11OtherELDERHEALTH
PA19236Other19236
393306OtherHEALTH AMERICA
393306OtherCIGNA
393306OtherDEVON
P039817OtherCHAMPUS TRICARE
PA1700OtherIBC KHPE
PA1058482OtherKEYSTONE MERCY SPU
PA1058480OtherKEYSTONE MERCY - INPT
393306OtherPRIVATE HEALTHCARE
PA1700OtherIBC KHPE