Healthcare Provider Details

I. General information

NPI: 1235394800
Provider Name (Legal Business Name): BELLEFONTE PHYSICIAN SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 11/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAINT CHRISTOPHER DR STE 320
ASHLAND KY
41101-7000
US

IV. Provider business mailing address

PO BOX 2155
ASHLAND KY
41105-2155
US

V. Phone/Fax

Practice location:
  • Phone: 606-833-0311
  • Fax:
Mailing address:
  • Phone: 606-833-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

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