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Organization
FORNANCE PHYSICIAN SERVICES, INC.
Active
Organization
FORNANCE PHYSICIAN SERVICES, INC.
Active
Other names
King of Prussia Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE RICE (CREDENTIALING SPECIALIST)
(484) 622-7371
Entity
Organization
Contact information
Practice address
210 MALL BLVD STE 102, KING OF PRUSSIA, PA 19406-3260
(610) 265-0726
(610) 265-3132
Mailing address
PO BOX 789967, PHILADELPHIA, PA 19178-9967
(484) 622-7395
(484) 622-7399
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NULL
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0418121001
AMERIHEALTH/INTERCOUNTY
PA
01
—
1112971
KEYSTONE MERCY
PA
05
—
1738323
—
PA
01
—
2047128
AETNA HMO
PA
01
—
26575
HEALTH PARTNERS SITE #
PA
01
—
5242713
AETNA PPO
PA
01
—
639587
HIGHMARK BLUE SHIELD
PA
01
—
6522623
CIGNA HMO/PPO
PA
01
—
CI4349
RRM
PA
Enumeration date
05/27/2006
Last updated
11/10/2018
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