Organization
TEMPLE UNIVERSITY CHILDRENS MEDICAL CENTER
Active
Parent organization
TEMPLE UNIVERSITY CHILDRENS MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
TEMPLE UNIVERSITY CHILDRENS MEDICAL CENTER
Authorized official
MR. ROBERT LUX (VP AND CFO)
(215) 707-3802
Entity
Organization
Contact information
Practice address
3509 N BROAD ST, PHILADELPHIA, PA 19140-4105
(215) 707-5303
Mailing address
3509 N BROAD ST, PHILADELPHIA, PA 19140-4105
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
101901
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1004908
AETNA USHC
—
05
—
1007287550001
—
PA
01
—
1058480
HORIZON NJ
NJ
01
—
1058480
KEYSTONE MERCY - INPT
PA
01
—
1058481
KEYSTONE MERCY OUTPT
PA
01
—
1058482
KEYSTONE MERCY SPU
PA
01
—
11
ELDERHEALTH
PA
01
—
1700
IBC KHPE
PA
01
—
19236
19236
PA
01
—
393306
UNITED HEALTHCARE
—
01
—
P039817
CHAMPUS TRICARE
—
Enumeration date
01/23/2007
Last updated
07/16/2007
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