Provider Demographics
NPI:1225018526
Name:FORNANCE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC.
Other - Org Name:INTERVENTIONAL ASSOCIATES
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:PO BOX 8500-9967
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:484-622-1365
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30026844OtherKEYSTONE MERCY
PA08722OtherHEALTH PARTNERS
PA1738323Medicaid
PA1643760OtherHIGHMARK BLUE SHIELD
PA23-2275591OtherPHCS
PA2319700000OtherIBC - PC, KHPE
PA0700330901OtherAMERICHOICE/HMA (UHC MA)
PA23-2275591OtherUNITED HEALTHCARE
PA2319700000OtherAMERIHEALTH/INTERCOUNTY
PA459451OtherAETNA
PA0700330901OtherAMERICHOICE/HMA (UHC MA)
PA=========OtherMAMSI(ALLIANCE,OPT CHC)
PA23-2275591OtherUNITED HEALTHCARE
PA=========OtherMULTIPLAN