Healthcare Provider Details

I. General information

NPI: 1316125701
Provider Name (Legal Business Name): FORNANCE PHYSICIAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2008
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 POWELL ST STE 100
NORRISTOWN PA
19401
US

IV. Provider business mailing address

PO BOX 789667
PHILADELPHIA PA
19178-9967
US

V. Phone/Fax

Practice location:
  • Phone: 484-622-7395
  • Fax: 484-622-7399
Mailing address:
  • Phone: 484-622-7618
  • Fax: 610-270-0163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: VERA BURNETTROBINS
Title or Position: DIRECTOR PHYSICIAN BILLING
Credential:
Phone: 484-622-7391