Provider Demographics
NPI:1497970487
Name:ASHLAND BELLEFONTE OB-GYN
Entity Type:Organization
Organization Name:ASHLAND BELLEFONTE OB-GYN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MRUDULA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-836-8188
Mailing Address - Street 1:PO BOX 2256
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2256
Mailing Address - Country:US
Mailing Address - Phone:606-836-8188
Mailing Address - Fax:606-836-8177
Practice Address - Street 1:1101 SAINT CHRISTOPHER DR
Practice Address - Street 2:STE. 340
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7087
Practice Address - Country:US
Practice Address - Phone:606-836-8188
Practice Address - Fax:606-836-8177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY19399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64193998Medicaid
KY1440401Medicare ID - Type Unspecified
KY64193998Medicaid