Provider Demographics
NPI:1033189600
Name:FORNANCE PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC
Other - Org Name:FORNANCE HOSPITAL SERVICE
Other - Org Type:Doing Business As
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 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-7071
Practice Address - Fax:484-622-4260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1738323Medicaid
PA0706828000OtherAMERIHEALTH/INTERCOUNTY
PA31712OtherHEALTH PARTNERS
PA0706828000OtherIBC - PC, KHPE
PA017487OtherHIGHMARK BLUE SHIELD
PA1152985OtherKEYSTONE MERCY
PAGC6886OtherRR MEDICARE
PA2582595OtherAETNA HMO
PA=========OtherUNHC
PA0706828000OtherIBC - PC, KHPE
PA1738323Medicaid
PA31712OtherHEALTH PARTNERS