Provider Demographics
NPI:1134318173
Name:LESLEY P ABBOTT, DO, PSC
Entity Type:Organization
Organization Name:LESLEY P ABBOTT, DO, PSC
Other - Org Name:BELLEFONTE FAMILY MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-836-0165
Mailing Address - Street 1:903 BELLEFONTE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139-2005
Mailing Address - Country:US
Mailing Address - Phone:606-836-0165
Mailing Address - Fax:
Practice Address - Street 1:903 BELLEFONTE RD
Practice Address - Street 2:SUITE B
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-2005
Practice Address - Country:US
Practice Address - Phone:606-836-0165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02808207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDC2508OtherRAILROAD MEDICARE
KY64081524Medicaid
KY9326Medicare PIN