Provider Demographics
NPI:1609176544
Name:FORNANCE PHYSICIAN SERVICES
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES
Other - Org Name:FAMILY PRACTICE ASSOC OF KOP OF FORNANCE
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 1:625 CLARK AVE
Mailing Address - Street 2:SUITE 13
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-1438
Mailing Address - Country:US
Mailing Address - Phone:610-265-8566
Mailing Address - Fax:610-878-2620
Practice Address - Street 1:625 CLARK AVE
Practice Address - Street 2:SUITE 13
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-1438
Practice Address - Country:US
Practice Address - Phone:610-265-8566
Practice Address - Fax:610-878-2620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty