Provider Demographics
NPI:1962482257
Name:FORNANCE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC.
Other - Org Name:PATHOLOGY GROUP FORNANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
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 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-1435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathologyGroup - Multi-Specialty
No207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Multi-Specialty
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1738323Medicaid
PA444943OtherHIGHMARK BLUE SHIELD
PA47046OtherKEYSTONE MERCY
PA622047OtherTRIGON BLUE SHIELD
PA0048037000OtherAMERICHOICE/INTERCOUNTY
PA0048037000OtherIBC - PC, KHPE
PAG0001885OtherAMERICHOICE
PA2032281OtherAETNA
PA08723OtherHEALTH PARTNERS
PA=========OtherAMERICARE/DEVON
PAG0001885OtherAMERICHOICE
PA2032281OtherAETNA
PA=========OtherMULTIPLAN
PA=========OtherPHCS