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1225018526

NPI Code Detail

MEDICARE: FORNANCE PHYSICIAN SERVICES, INC.

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	2085R0202X	Diagnostic Radiology Physician
2	363L00000X	Nurse Practitioner
3	2085R0204X	Vascular & Interventional Radiology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	30026844	OTHER	PA	KEYSTONE MERCY
2	08722	OTHER	PA	HEALTH PARTNERS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1643760	OTHER	PA	HIGHMARK BLUE SHIELD
5	23-2275591	OTHER	PA	PHCS
6	2319700000	OTHER	PA	IBC - PC, KHPE
7	0700330901	OTHER	PA	AMERICHOICE/HMA (UHC MA)
8	23-2275591	OTHER	PA	UNITED HEALTHCARE
9	2319700000	OTHER	PA	AMERIHEALTH/INTERCOUNTY
10	459451	OTHER	PA	AETNA

General Provider Information

NPI Number	:	1225018526
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	:	559 W GERMANTOWN PIKE
Second Line	:
City	:	EAST NORRITON
State	:	PA
Zip	:	19403-4250
Country	:	US
Telephone Number	:	484-622-1365
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR PHYSICIAN BILLING
Name	:	VERA BURNETT-ROBINS
Credential	:
Telephone Number	:	484-622-7391

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	08/17/2018

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

Language	Start Address	Practice Location

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