Provider Demographics
NPI:1053363523
Name:FORNANCE PHYSICIAN SERVICES, INC
Entity type:Organization
Organization Name:FORNANCE PHYSICIAN SERVICES, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:484-622-7371
Mailing Address - Fax:484-622-7399
Practice Address - Street 1:1330 POWELL ST
Practice Address - Street 2:STE 507
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3353
Practice Address - Country:US
Practice Address - Phone:484-622-7300
Practice Address - Fax:484-622-7310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-16
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PACI9345OtherRRM
PA27073OtherHEALTH PARTNERS
PA1009201OtherKEYSTONE MERCY
PA1009201OtherKEYSTONE MERCY