# FORNANCE PHYSICIAN SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** King of Prussia Family Medicine
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831146919
- **Authorized official:** SUZANNE RICE (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (484) 622-7371

## Contact information

- **Practice address:** 210 MALL BLVD STE 102, KING OF PRUSSIA, PA 19406-3260
- **Practice address phone:** (610) 265-0726
- **Practice address fax:** (610) 265-3132
- **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 | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 05/27/2006
- **Last updated:** 11/10/2018

## 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 |