=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124269261
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEMPLE UNIVERSITY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2009
-----------------------------------------------------
Last Update Date | 03/19/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 612 W NAOMI ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19144-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-740-2763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 612 W NAOMI ST
-----------------------------------------------------
City | PHILADELPHIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19144-3711
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-740-2763
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CONTACT PERSON
-----------------------------------------------------
Name | MS. TRACY CLARK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 215-707-4739
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 273Y00000X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Hospital Unit
-----------------------------------------------------
License Number | MT049178T
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------