MEDICARE: BELL CLINIC PLLC

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	207Q00000X	Family Medicine Physician		KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00819	OTHER	KY	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	18D0953137	OTHER	KY	CLIA

General Provider Information

NPI Number	:	1790935997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELL CLINIC PLLC

Provider Business Mailing Address
First Line	:	PO BOX 187
Second Line	:
City	:	ELKTON
State	:	KY
Zip	:	42220-0187
Country	:	US
Telephone Number	:	270-265-2575
Fax Number	:	270-265-3098

Provider Business Practice Location Address
First Line	:	105 ELK FORK RD
Second Line	:
City	:	ELKTON
State	:	KY
Zip	:	42220-0000
Country	:	US
Telephone Number	:	270-265-2575
Fax Number	:	270-265-3098

Authorized Official
Title or Position	:	OWNER
Name	:	GEETA CHAVDA
Credential	:	M.D.
Telephone Number	:	270-265-2575

Provider Enumeration Date	:	09/24/2008
Last Update Date	:	08/06/2010

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Directions to “BELL CLINIC PLLC ” Practice Location

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