Provider Demographics
NPI:1881846350
Name:BELLEFONTE PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:BELLEFONTE PHYSICIAN SERVICES, INC
Other - Org Name:BELLEFONTE FAMILY MEDICINE ASSOCIATES
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:606-833-4681
Mailing Address - Fax:
Practice Address - Street 1:903 BELLEFONTE RD
Practice Address - Street 2:STE. B
Practice Address - City:FLATWOODS
Practice Address - State:KY
Practice Address - Zip Code:41139-2005
Practice Address - Country:US
Practice Address - Phone:606-836-0165
Practice Address - Fax:606-836-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000606034OtherANTHEM BCBS
KY7100071320Medicaid
KYDN8303OtherRR MEDICARE
KY00949Medicare PIN