Provider Demographics
NPI:1659307585
Name:OUR LADY OF BELLEFONTE HOSPITAL
Entity Type:Organization
Organization Name:OUR LADY OF BELLEFONTE HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAN
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTINUS
Authorized Official - Middle Name:J
Authorized Official - Last Name:LOBACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-836-3900
Mailing Address - Street 1:2420 ARGILLITE ROAD SUITE B
Mailing Address - Street 2:
Mailing Address - City:FLATWOODS
Mailing Address - State:KY
Mailing Address - Zip Code:41139
Mailing Address - Country:US
Mailing Address - Phone:606-836-3900
Mailing Address - Fax:606-836-0205
Practice Address - Street 1:2420 ARGILLITE ROAD
Practice Address - Street 2:SUITE B
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139
Practice Address - Country:US
Practice Address - Phone:606-836-3900
Practice Address - Fax:606-836-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY28383207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304705Medicaid
KY64063993Medicaid
0641206Medicare ID - Type Unspecified
KY64063993Medicaid