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	261QA1903X	Ambulatory Surgical Clinic/Center	15661501	PA

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
2	735070	OTHER	PA	HEALTH AMERICA HEALTH ASSURANCE/ COVENTRY/ FIRST HEALTH
3	HU833	OTHER	PA	INTER COUNTY HEALTH PLAN
4	U833	OTHER	PA	KEYSTONE MERCY/ AMERI HEALTH
5	37394	OTHER	PA	HEALTH PARTNERS
6	116487100	OTHER	PA	US DEPARTMENT OF LABOR
7	2063664	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1386646891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEMPLE UNIVERSITY OF THE COMMONWEALTH SYSTEM OF HIGHER EDUCATION

Provider Business Mailing Address
First Line	:	PO BOX 827282
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19182-7282
Country	:	US
Telephone Number	:	215-625-5341
Fax Number	:	215-629-0716

Provider Business Practice Location Address
First Line	:	8TH AT RACE STREET
Second Line	:	SECOND FLOOR
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-0000
Country	:	US
Telephone Number	:	215-625-5381
Fax Number	:	215-629-4904

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. LARRY MARK NEWMAN
Credential	:	D.P.M
Telephone Number	:	215-625-5310

Provider Enumeration Date	:	08/15/2005
Last Update Date	:	04/10/2013

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