Provider Demographics
NPI:1275574626
Name:FORNANCE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC.
Other - Org Name:TRAPPE FAMILY PRACTICE
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:BURNETTROBINS
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 1:17 IRON BRIDGE DR STE 150
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2042
Practice Address - Country:US
Practice Address - Phone:484-622-6320
Practice Address - Fax:484-622-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000632OtherAETNA HMO
PA0282590OtherCIGNA HMO/PPO
PA0047325001OtherIBC - PC/KHPE
PA0047325001OtherAMERIHEALTH/INTERCOUNTY
PA2124456OtherALLIANCE/OPT CHC (MAMSI)
PA4449601OtherAETNA PPO
PA1026741OtherKEYSTONE MERCY
PA16452OtherHEALTH PARTNERS SITE#
PA1738323Medicaid
PA484046OtherHIGHMARK BLUE SHIELD
PACI6428OtherRRM
PA2124456OtherALLIANCE/OPT CHC (MAMSI)