1285674846 NPI number — FORNANCE PHYSICIAN SERVICES, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285674846 NPI number — FORNANCE PHYSICIAN SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FORNANCE PHYSICIAN SERVICES, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285674846
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 789967
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHILADELPHIA
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19178-9967
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-622-7395
Provider Business Mailing Address Fax Number:
484-622-7399

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 POWELL ST
Provider Second Line Business Practice Location Address:
SUITE 409
Provider Business Practice Location Address City Name:
NORRISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19401-3353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-277-0964
Provider Business Practice Location Address Fax Number:
610-270-2184
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURNETT-ROBINS
Authorized Official First Name:
VERA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR PHYSICIAN BILLING
Authorized Official Telephone Number:
484-622-7391

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 17713 . This is a "HEALTH PARTNERS SITE #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: CC4910 . This is a "RRM" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0047315001 . This is a "IBC - PC/KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 444971 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018110 . This is a "AETNA HMO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1016391 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2326372 . This is a "CIGNA HMO/PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0047315001 . This is a "AMERIHEALTH/INTERCOUNTY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1738323 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4439614 . This is a "AETNA PPO" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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