Provider Demographics
NPI:1417927187
Name:FORNANCE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC.
Other - Org Name:MONTGOMERY RADIATION ONCOLOGY
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 820137
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-0137
Mailing Address - Country:US
Mailing Address - Phone:610-270-2352
Mailing Address - Fax:610-270-2358
Practice Address - Street 1:1330 POWELL ST
Practice Address - Street 2:SUITE 308
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3353
Practice Address - Country:US
Practice Address - Phone:610-270-2192
Practice Address - Fax:610-270-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-25
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0194239000OtherAMERIHEALTH/INTERCOUNTY
PA054706OtherHIGHMARK BLUE SHIELD
PA1053316OtherKEYSTONE MERCY
PA0194239000OtherIBC - PC, KHPE
PA1738323Medicaid
PA5015635OtherAETNA PPO
PA25096OtherHEALTH PARTNERS
PA2110590OtherAETNA HMO
PA1053316OtherKEYSTONE MERCY
PA=========OtherAMERICARE/DEVON
PA1738323Medicaid
PA2110590OtherAETNA HMO