MEDICARE: OUR LADY OF BELLEFONTE HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207RI0011X	Interventional Cardiology Physician
2	363L00000X	Nurse Practitioner
3	207RC0000X	Cardiovascular Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000551196	OTHER	KY	ANTHEM BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083823421
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR LADY OF BELLEFONTE HOSPITAL

Provider Business Mailing Address
First Line	:	1180 SAINT CHRISTOPHER DR
Second Line	:	STE. 2
City	:	ASHLAND
State	:	KY
Zip	:	41101-7055
Country	:	US
Telephone Number	:	606-833-0144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 SAINT CHRISTOPHER DR
Second Line	:	STE. 2
City	:	ASHLAND
State	:	KY
Zip	:	41101-7055
Country	:	US
Telephone Number	:	606-833-0144
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. JOE BUCCHEIT
Credential	:
Telephone Number	:	606-833-3333

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	09/15/2008

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