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General NPI Number Information
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NPI Number | 1497792931
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Entity Type | Organization
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Legal Business Name | FORNANCE PHYSICIAN SERVICES, INC.
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 11/14/2018
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Provider Practice Location Address
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Address Line | 4070 BUTLER PIKE STE 200
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1510
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Country | US
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Telephone | 108-255-7416
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Fax | 610-825-2501
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Provider Business Mailing Address
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Address Line | PO BOX 789967
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City | PHILADELPHIA
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State | PA
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Zip | 19178-9967
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Country | US
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Telephone | 484-622-7395
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Fax | 484-622-7399
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Authorized Official
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Title or Position | DIRECTOR PHYSICIAN BILLING
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Name | VERA BURNETT-ROBINS
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Credential |
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Telephone | 484-622-7391
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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