Provider Demographics
NPI:1043464589
Name:BELLEFONTE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:BELLEFONTE PHYSICIAN SERVICES, INC.
Other - Org Name:BELLEFONTE WOMEN'S CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-833-3333
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2155
Mailing Address - Country:US
Mailing Address - Phone:606-833-4922
Mailing Address - Fax:
Practice Address - Street 1:2001 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7743
Practice Address - Country:US
Practice Address - Phone:606-324-7351
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X, 363A00000X, 363AM0700X, 363LF0000X, 363LX0001X
KY6081P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's HealthGroup - Multi-Specialty
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2875296Medicaid
KY7100052850Medicaid
KY000000583780OtherANTHEM BCBS
KY7100052870Medicaid
KY000000583780OtherANTHEM BCBS
KY7100052850Medicaid