Healthcare Provider Details

I. General information

NPI: 1306907480
Provider Name (Legal Business Name): OUR LADY BELLEFONTE HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7055
US

IV. Provider business mailing address

1150 SAINT CHRISTOPHER DR
ASHLAND KY
41101-7055
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number40015
License Number StateKY

VIII. Authorized Official

Name: CHRIS WILDE
Title or Position: CFO
Credential:
Phone: 606-833-0144