Healthcare Provider Details

I. General information

NPI: 1710130406
Provider Name (Legal Business Name): BELLEFONTE PHYSICIAN SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAINT CHRISTOPHER DR STE 200
ASHLAND KY
41101-7087
US

IV. Provider business mailing address

PO BOX 2155
ASHLAND KY
41105-2155
US

V. Phone/Fax

Practice location:
  • Phone: 606-833-6210
  • Fax: 606-833-6213
Mailing address:
  • Phone: 606-833-4922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

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