Healthcare Provider Details

I. General information

NPI: 1760634745
Provider Name (Legal Business Name): BELLEFONTE PHYSICIAN SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 SAINT CHRISTOPHER DR STE2
ASHLAND KY
41101-7055
US

IV. Provider business mailing address

PO BOX 2155
ASHLAND KY
41105-2155
US

V. Phone/Fax

Practice location:
  • Phone: 606-833-0144
  • Fax: 606-833-0113
Mailing address:
  • Phone: 606-833-4680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: TROY CONNETT
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 606-833-3333