39D1100989 CLIA NUMBER - TEMPLE FAMILY MEDICINE - OLD BUSTLETON

Laboratory Demographics

CLIA Number: 39D1100989

Facility Name: TEMPLE FAMILY MEDICINE - OLD BUSTLETON

Facility Address:
9331 OLD BUSTLETON AVENUE SUITE 100
PHILADELPHIA, PA
ZIP 19115
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Facility Phone Number: 215 671-0653

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1164841946

Taxonomy: 207Q00000X - Family Medicine
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

CLIA Record

Field Name	Field Value
CLIA Number	39D1100989
LAB Type	Physician Office
Facility Name	TEMPLE FAMILY MEDICINE - OLD BUSTLETON
Street	9331 OLD BUSTLETON AVENUE SUITE 100
City	PHILADELPHIA
State	PA
ZIP	19115
Phone	215 671-0653
CertificateType	4
CertificateEffectiveDate	6/18/2023
CertificateExpirationDate	6/17/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024