Provider Demographics
NPI:1497792931
Name:FORNANCE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC.
Other - Org Name:PLYMOUTH MEETING FAMILY MEDICINE
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 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 1:4070 BUTLER PIKE STE 200
Practice Address - Street 2:
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1510
Practice Address - Country:US
Practice Address - Phone:108-255-7416
Practice Address - Fax:610-825-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA36452OtherHEALTH PARTNERS
PA0005380OtherAETNA HMO
PA2124021OtherALLIANCE/OPT CHC (MAMSI)
PA454610OtherHIGHMARK BLUE SHIELD
PA0047317001OtherIBC - PC/KHPE
PA1738323OtherOMAP
PA4439597OtherAETNA PPO
PA0047317001OtherAMERIHEALTH/INTERCOUNTY
PA0282506OtherCIGNA HMO/PPO
PA1026915OtherKEYSTONE MERCY
PACI1395OtherRRM
PA0047317001OtherAMERIHEALTH/INTERCOUNTY