39D2128080 CLIA NUMBER - TEMPLE PRIMARY CARE AT STAPELEY

Laboratory Demographics

CLIA Number: 39D2128080

Facility Name: TEMPLE PRIMARY CARE AT STAPELEY

Facility Address:
7602 CENTRAL AVE, STE 101
PHILADELPHIA, PA
ZIP 19111
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Facility Phone Number: 215 969-2900

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1740641414

Taxonomy: 208D00000X - General Practice
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee

CLIA Record

Field Name	Field Value
CLIA Number	39D2128080
LAB Type	Physician Office
Facility Name	TEMPLE PRIMARY CARE AT STAPELEY
Street	7602 CENTRAL AVE, STE 101
City	PHILADELPHIA
State	PA
ZIP	19111
Phone	215 969-2900
CertificateType	4
CertificateEffectiveDate	3/24/2023
CertificateExpirationDate	3/23/2025
FacilityType	Waiver

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