MEDICARE: OUR LADY BELLEFONTE HOSPITAL, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	40015	KY

General Provider Information

NPI Number	:	1306907480
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR LADY BELLEFONTE HOSPITAL, INC

Provider Business Mailing Address
First Line	:	1150 SAINT CHRISTOPHER DR
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-7055
Country	:	US
Telephone Number	:	606-833-0144
Fax Number	:	606-833-0113

Provider Business Practice Location Address
First Line	:	1150 SAINT CHRISTOPHER DR
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41101-7055
Country	:	US
Telephone Number	:	606-833-0144
Fax Number	:	606-833-0113

Authorized Official
Title or Position	:	CFO
Name	:	CHRIS WILDE
Credential	:
Telephone Number	:	606-833-0144

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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