Provider Demographics
NPI:1801026125
Name:TEMPLE PHYSICIANS INC
Entity type:Organization
Organization Name:TEMPLE PHYSICIANS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-926-9050
Mailing Address - Street 1:9331 OLD BUSTLETON AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-4204
Mailing Address - Country:US
Mailing Address - Phone:215-671-0653
Mailing Address - Fax:215-671-0970
Practice Address - Street 1:9331 OLD BUSTLETON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19115-4204
Practice Address - Country:US
Practice Address - Phone:215-671-0653
Practice Address - Fax:215-671-0970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEMPLE PHYSICIANS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-21
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No163WG0600XNursing Service ProvidersRegistered NurseGerontologyGroup - Multi-Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACD4829OtherRR MEDICARE
PA597586OtherMEDICARE GROUP
PA597586OtherMEDICARE GROUP