Provider Demographics
NPI:1437104296
Name:FORNANCE PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC
Other - Org Name:CONSHOHOCKEN 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 1:612 FAYETTE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:CONSHOHOCKEN
Practice Address - State:PA
Practice Address - Zip Code:19428-1797
Practice Address - Country:US
Practice Address - Phone:610-828-8500
Practice Address - Fax:610-828-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0565797001OtherAMERICHOICE/INTERCOUNTY
PACC5657OtherRRM
PA000059OtherAETNA HMO
PA05657970001OtherIBC - PC/KHPE
PA1021702OtherKEYSTONE MERCY
PA17213OtherSITE# FOR HEALTH PARTNERS
PA0282527OtherCIGNA HMO/PPO
PA4439611OtherAETNA PPO
PA727928OtherHIGHMARK BLUE SHIELD
PACC5657OtherRRM