MEDICARE: BELLEFONTE PHYSICIAN SERVICES, INC

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	363A00000X	Physician Assistant
3	363L00000X	Nurse Practitioner
4	363LF0000X	Family Nurse Practitioner
5	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	DN8303	OTHER	KY	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000598306	OTHER	KY	ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	9208310	OTHER	KY	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760634745
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLEFONTE PHYSICIAN SERVICES, INC

Provider Business Mailing Address
First Line	:	PO BOX 2155
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41105-2155
Country	:	US
Telephone Number	:	606-833-4680
Fax Number	:

Provider Business Practice Location Address
First Line	:	1180 SAINT CHRISTOPHER DR
Second Line	:	STE2
City	:	ASHLAND
State	:	KY
Zip	:	41101-7055
Country	:	US
Telephone Number	:	606-833-0144
Fax Number	:	606-833-0113

Authorized Official
Title or Position	:	DIRECTOR OF FINANCE
Name	:	TROY CONNETT
Credential	:
Telephone Number	:	606-833-3333

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	05/17/2019

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