1750351342 NPI number — FORNANCE PHYSICIAN SERVICES, INC.

Table of content: (NPI 1750351342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750351342 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:
1750351342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 820137
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:
19182-0137
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-270-2352
Provider Business Mailing Address Fax Number:
610-270-2358

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 POWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORRISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19401-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-270-2771
Provider Business Practice Location Address Fax Number:
610-270-2772
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LOWE-ROBBINS
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
REIMBURSEMENT MANAGER
Authorized Official Telephone Number:
610-270-2352

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2080N0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1770604 . This is a "HIGHMARK BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2453154000 . This is a "IBC - PC, KHPE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2453154000 . This is a "AMERIHEALTH/INTERCOUNTY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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