Provider Demographics
NPI:1952810988
Name:FORNANCE PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC
Other - Org Name:EINSTEIN PHYSICIANS BLUEBELL
Other - Org Type:Other Name
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 1:676 DEKALB PIKE STE 104
Practice Address - Street 2:
Practice Address - City:BLUE BELL
Practice Address - State:PA
Practice Address - Zip Code:19422-1223
Practice Address - Country:US
Practice Address - Phone:102-333-8956
Practice Address - Fax:610-272-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-21
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
232275591OtherUNITED HEALTHCARE
232275591OtherCIGNA HMO/PPO
232275591OtherUHC- AMERICHOICE
=========OtherMAMSI (ALLIANCE , OPT, CHC)
=========OtherIBC-PC, KHPE