Provider Demographics
NPI:1760634745
Name:BELLEFONTE PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:BELLEFONTE PHYSICIAN SERVICES, INC
Other - Org Name:BELLEFONTE HEART 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 1:1180 SAINT CHRISTOPHER DR
Practice Address - Street 2:STE2
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7055
Practice Address - Country:US
Practice Address - Phone:606-833-0144
Practice Address - Fax:606-833-0113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000598306OtherANTHEM BCBS
OH2927337Medicaid
KY7100066000Medicaid
KY9208310OtherAETNA
KY7100065810Medicaid
KYDN8303OtherRR MEDICARE
KY000000598306OtherANTHEM BCBS