MEDICARE: FORNANCE PHYSICIAN SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207RG0100X	Gastroenterology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	CI5752	OTHER	PA	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	47324	OTHER	PA	KEYSTONE MERCY
2	752461	OTHER	PA	HIGHMARK BLUE SHIELD
4	0545894000	OTHER	PA	IBC - PC, KHPE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	0545894000	OTHER	PA	AMERIHEALTH/INTERCOUNTY
7	26687	OTHER	PA	HEALTH PARTNERS
8	5261299	OTHER	PA	AETNA PPO
9	2142647	OTHER	PA	AETNA HMO

General Provider Information

NPI Number	:	1215907811
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FORNANCE PHYSICIAN SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 8500-9967
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-9967
Country	:	US
Telephone Number	:	484-622-7395
Fax Number	:	484-622-7399

Provider Business Practice Location Address
First Line	:	1330 POWELL ST
Second Line	:	SUITE 310
City	:	NORRISTOWN
State	:	PA
Zip	:	19401-3353
Country	:	US
Telephone Number	:	610-277-2635
Fax Number	:	610-270-2786

Authorized Official
Title or Position	:	REIMBURSEMENT MANAGER
Name	:	KAREN LOWE-ROBBINS
Credential	:
Telephone Number	:	484-622-7382

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	08/17/2018

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Directions to “FORNANCE PHYSICIAN SERVICES, INC. ” Practice Location

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