Provider Demographics
NPI:1013997386
Name:FORNANCE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC.
Other - Org Name:EMERGENCY GROUP 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: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 1:1301 POWELL ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3323
Practice Address - Country:US
Practice Address - Phone:610-270-2060
Practice Address - Fax:610-270-2652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-20
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50585OtherAETNA
PACG6886OtherRR MEDICARE
PA0048792000OtherIBC - PC, KHPE
PA0048792000OtherAMERIHEALTH/INTERCOUNTY
PA07237OtherHEALTH PARTNERS
PA123787OtherHIGHMARK BLUE SHIELD
PA40079EMOtherKEYSTONE MERCY
PA00758608OtherAMERICHOICE
PA123787OtherHIGHMARK BLUE SHIELD
PA=========OtherCIGNA HMO/PPO
PA=========OtherPHCS
PA=========OtherALLIANCE (MAMSI)
PA=========OtherMULTIPLAN
PA=========OtherUHC
PA=========OtherDEVON (AMERICARE)