Provider Demographics
NPI:1184694705
Name:FORNANCE PHYSICIAN SERVICES, INC.
Entity type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURNETT-ROBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:484-622-7391
Mailing Address - Street 1:PO BOX 789967
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-9967
Mailing Address - Country:US
Mailing Address - Phone:484-622-7395
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:609 W GERMANTOWN PIKE STE 220
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4261
Practice Address - Country:US
Practice Address - Phone:484-622-7940
Practice Address - Fax:484-622-7950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0329132000OtherIBC - PC, KHPE
PA1002082OtherKEYSTONE MERCY
PA16728OtherHEALTH PARNERS
PA0112141OtherAETNA HMO
PA135835OtherHIGHMARK BLUE SHIELD
PA5074146OtherAETNA PPO
PA0329132000OtherAMERIHEALTH/INTERCOUNTY
PA=========OtherUNHC
PA0112141OtherAETNA HMO
PA0329132000OtherAMERIHEALTH/INTERCOUNTY
PA=========OtherMAMSI
PA=========OtherCIGNA HMO/PPO