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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
207R00000X
Internal Medicine Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0418121001
IBC - PC/KHPE
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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