Provider Demographics
NPI:1912200114
Name:BELLEFONTE PHYSICIAN SERVICES, INC
Entity Type:Organization
Organization Name:BELLEFONTE PHYSICIAN SERVICES, INC
Other - Org Name:BELLEFONTE DIGESTIVE DISEASE CENTER
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:877-214-4267
Mailing Address - Fax:606-833-4668
Practice Address - Street 1:1101 SAINT CHRISTOPHER DR STE 350
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7000
Practice Address - Country:US
Practice Address - Phone:606-833-6350
Practice Address - Fax:606-833-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDN8303OtherRRMC
KY0000006921893OtherANTHEM BCBS
KY0000006921893OtherANTHEM BCBS