MEDICARE: TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306833132
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Provider Business Mailing Address
First Line	:	3425 N CARLISLE ST
Second Line	:	2ND FLOOR, HUDSON BUILDING
City	:	PHILADELPHIA
State	:	PA
Zip	:	19140-5108
Country	:	US
Telephone Number	:	215-707-4739
Fax Number	:	215-707-3677

Provider Business Practice Location Address
First Line	:	7604 CENTRAL AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19111-2433
Country	:	US
Telephone Number	:	215-214-6655
Fax Number	:	215-214-6654

Authorized Official
Title or Position	:	CFO
Name	:	MR. THOMAS G KUPP
Credential	:
Telephone Number	:	215-707-7551

Provider Enumeration Date	:	10/06/2005
Last Update Date	:	11/10/2008

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