Provider Demographics
NPI:1083823421
Name:OUR LADY OF BELLEFONTE HOSPITAL
Entity Type:Organization
Organization Name:OUR LADY OF BELLEFONTE HOSPITAL
Other - Org Name:BELLEFONTE HEART CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCCHEIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-833-3333
Mailing Address - Street 1:1180 SAINT CHRISTOPHER DR
Mailing Address - Street 2:STE. 2
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7055
Mailing Address - Country:US
Mailing Address - Phone:606-833-0144
Mailing Address - Fax:
Practice Address - Street 1:1180 SAINT CHRISTOPHER DR
Practice Address - Street 2:STE. 2
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7055
Practice Address - Country:US
Practice Address - Phone:606-833-0144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2793946Medicaid
KY000000551196OtherANTHEM BCBS
KY7100011690Medicaid
KY7100011690Medicaid
KYCB3982Medicare PIN