Provider Demographics
NPI:1770550089
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:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:FLOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-707-6606
Mailing Address - Street 1:PO BOX 820890
Mailing Address - Street 2:TEMPLE PEDIATRIC EMERGENCY MEDICAL ASSOCIATES
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0890
Mailing Address - Country:US
Mailing Address - Phone:800-666-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:3509 N BROAD ST
Practice Address - Street 2:TEMPLE UNIVERSITY CHILDRENS MEDICAL CENTER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19140
Practice Address - Country:US
Practice Address - Phone:215-707-6606
Practice Address - Fax:215-707-6629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007780130283Medicaid
PA278955OtherHIGHMARK BLUE SHIELD
PA0647502000OtherINDEPENDENCE BLUE CROSS
PA0647502000OtherINDEPENDENCE BLUE CROSS