# FORNANCE PHYSICIAN SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Montgomery Family Practice
- **Organization subpart:** No

## Provider details

- **NPI number:** 1285674846
- **Authorized official:** VERA BURNETT-ROBINS (DIRECTOR PHYSICIAN BILLING)
- **Authorized official phone:** (484) 622-7391

## Contact information

- **Practice address:** 1330 POWELL ST, SUITE 409, NORRISTOWN, PA 19401-3353
- **Practice address phone:** (610) 277-0964
- **Practice address fax:** (610) 270-2184
- **Mailing address:** PO BOX 789967, PHILADELPHIA, PA 19178-9967
- **Mailing address phone:** (484) 622-7395
- **Mailing address fax:** (484) 622-7399

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | NULL | — |
| 207QG0300X | Geriatric Medicine (Family Medicine) Physician | — | — | — |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/08/2006
- **Last updated:** 11/14/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0018110 | AETNA HMO | PA |
| 01 | — | 0047315001 | IBC - PC/KHPE | PA |
| 01 | — | 1016391 | KEYSTONE MERCY | PA |
| 05 | — | 1738323 | — | PA |
| 01 | — | 17713 | HEALTH PARTNERS SITE \# | PA |
| 01 | — | 2326372 | CIGNA HMO/PPO | PA |
| 01 | — | 4439614 | AETNA PPO | PA |
| 01 | — | 444971 | HIGHMARK BLUE SHIELD | PA |
| 01 | — | CC4910 | RRM | PA |