Provider Demographics
NPI:1194035451
Name:FORNANCE PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC
Other - Org Name:JEFFERSONVILLE INTERNAL MEDICINE OF FORNANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REIMBURSEMENT/CREDENTIALING MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE ROBBINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-270-2352
Mailing Address - Street 1:1550 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-3228
Mailing Address - Country:US
Mailing Address - Phone:610-635-1712
Mailing Address - Fax:610-635-1716
Practice Address - Street 1:1550 W MAIN ST
Practice Address - Street 2:
Practice Address - City:JEFFERSONVILLE
Practice Address - State:PA
Practice Address - Zip Code:19403-3228
Practice Address - Country:US
Practice Address - Phone:610-635-1712
Practice Address - Fax:610-635-1716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA075473Medicare PIN