Provider Demographics
NPI:1578589685
Name:BELLEFONTE PATHOLOGY AND LABORATORY MEDICINE PSC
Entity Type:Organization
Organization Name:BELLEFONTE PATHOLOGY AND LABORATORY MEDICINE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LABORATORY MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-833-3634
Mailing Address - Street 1:PO BOX 1629
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-1629
Mailing Address - Country:US
Mailing Address - Phone:502-458-8653
Mailing Address - Fax:502-456-4440
Practice Address - Street 1:1000 SAINT CHRISTOPHER DR
Practice Address - Street 2:PATHOLOGY DEPT
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7034
Practice Address - Country:US
Practice Address - Phone:606-833-3634
Practice Address - Fax:606-836-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL608673400OtherWORKERS COMP FLORIDA
KYDC8843OtherRAILROAD MEDICARE
608673400OtherUS DEPT OF LABOR
KY7100240980Medicaid
KY000000355047OtherANTHEM BLUE CROSS BS
KY50006256OtherPASSPORT MEDICAID
WV3810003731Medicaid
608673400OtherBLACK LUNG PROGRAM
WV3810003731Medicaid
608673400OtherUS DEPT OF LABOR