Provider Demographics
NPI:1073904108
Name:FORNANCE PHYSICIAN SERVICES,INC
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES,INC
Other - Org Name:EINSTEIN PHYSICIANS-SHANNONDELL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR PHYSICIAN BILLING
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 1:20000 SHANNONDELL DR
Mailing Address - Street 2:
Mailing Address - City:AUDUBON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5653
Mailing Address - Country:US
Mailing Address - Phone:484-622-6401
Mailing Address - Fax:
Practice Address - Street 1:20000 SHANNONDELL DR
Practice Address - Street 2:
Practice Address - City:AUDUBON
Practice Address - State:PA
Practice Address - Zip Code:19403-5653
Practice Address - Country:US
Practice Address - Phone:484-622-6401
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-11
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty