Organization
FORNANCE PHYSICIAN SERVICES, INC
Active
Other names
Broad Axe Family Medicine
Organization subpart
No
Provider details
NPI number
Authorized official
VERA BURNETT-ROBINS (DIRECTOR PHYSICIAN BILLING)
(484) 622-7391
Entity
Organization
Contact information
Practice address
721 SKIPPACK PIKE, SUITE 3, BLUE BELL, PA 19422-1700
(215) 793-0600
(610) 793-0759
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0274457001
IBC - PC/KHPE
PA
01
—
085595
AETNA HMO
PA
01
—
1065049
KEYSTONE MERCY
PA
01
—
2120908
ALLIANCE (MAMSI)
PA
01
—
259541
HIGHMARK BLUE SHIELD
PA
01
—
33022
HEALTH PARTNERS SITE #
PA
01
—
5389597
AETNA PPO
PA
01
—
7990725
CIGNA HMO/PPO
PA
01
—
CI5397
RRM
PA
Enumeration date
05/20/2006
Last updated
11/15/2018
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