Provider Demographics
NPI:1356417497
Name:TEMPLE UNIVERSITY CHILDREN'S MEDICAL CENTER
Entity type:Organization
Organization Name:TEMPLE UNIVERSITY CHILDREN'S 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:215-707-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC2000XHospitalsGeneral Acute Care HospitalChildren
Provider Identifiers
StateIdentifier IDID TypeIssuer
393306OtherUNITED HEALTHCARE
PA0169638603OtherAMERICHOICE
PA1007287550001Medicaid
NJ1058480OtherHORIZON NJ
11OtherELDERHEALTH
393306OtherHEALTH AMERICA
PA1007287550002Medicaid
PA1058480OtherKEYSTONE MERCY
1058482OtherKEYSTONE MERCY SPU
1058481OtherKEYSTONE MERCY EMERGENCY
393306OtherCIGNA
AETNAOther1004908
PA001700OtherIBC KHPE
393306OtherPRIVATE HEALTHCARE
PO39817OtherCHAMPUS TRICARE
PA19236OtherHEALTH PARTNERS
393306OtherDEVON
AETNAOther1004908