Healthcare Provider Details

I. General information

NPI: 1659307585
Provider Name (Legal Business Name): OUR LADY OF BELLEFONTE HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 ARGILLITE ROAD SUITE B
FLATWOODS KY
41139
US

IV. Provider business mailing address

2420 ARGILLITE ROAD SUITE B
FLATWOODS KY
41139
US

V. Phone/Fax

Practice location:
  • Phone: 606-836-3900
  • Fax: 606-836-0205
Mailing address:
  • Phone: 606-836-3900
  • Fax: 606-836-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number28383
License Number StateKY

VIII. Authorized Official

Name: DR. AUGUSTINUS J LOBACH
Title or Position: PHYSICAN
Credential: MD
Phone: 606-836-3900