Healthcare Provider Details

I. General information

NPI: 1801876958
Provider Name (Legal Business Name): FORNANCE PHYSICIAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 W GERMANTOWN PIKE
EAST NORRITON PA
19403-4250
US

IV. Provider business mailing address

PO BOX 8500-9967
PHILADELPHIA PA
19178-9967
US

V. Phone/Fax

Practice location:
  • Phone: 484-622-1244
  • Fax: 484-622-1542
Mailing address:
  • Phone: 484-622-7395
  • Fax: 484-622-7399

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: KAREN LOWE-ROBBINS
Title or Position: REIMBURSEMENT MANAGER
Credential:
Phone: 484-622-7382