39D2097042 CLIA NUMBER - TEMPLE PHYSICIANS AT SOMERTON

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Laboratory Demographics

CLIA Number: 39D2097042

Facility Name: TEMPLE PHYSICIANS AT SOMERTON

Facility Address:
12000 BUSTLETON AVE, SUITE 102
PHILADELPHIA, PA
ZIP 19116
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Facility Phone Number: 215 673-7600

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1811248925

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	39D2097042
LAB Type	Physician Office
Facility Name	TEMPLE PHYSICIANS AT SOMERTON
Street	12000 BUSTLETON AVE, SUITE 102
City	PHILADELPHIA
State	PA
ZIP	19116
Phone	215 673-7600
CertificateType	4
CertificateEffectiveDate	6/8/2023
CertificateExpirationDate	6/7/2025
FacilityType	Waiver

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