Provider Demographics
NPI:1659526960
Name:BELLEFONTE PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:BELLEFONTE PHYSICIAN SERVICES, INC.
Other - Org Name:BELLEFONTE PRIMARY AND PEDIATRIC CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-833-3333
Mailing Address - Street 1:PO BOX 2155
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2155
Mailing Address - Country:US
Mailing Address - Phone:606-833-4680
Mailing Address - Fax:
Practice Address - Street 1:2028 WINCHESTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7744
Practice Address - Country:US
Practice Address - Phone:606-326-9001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-01
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100115550Medicaid
KY7100062530Medicaid
KYDN8303OtherRR MEDICARE
OH2913020Medicaid
KY000000598118OtherANTHEM BCBS
KY00853Medicare PIN