Provider Demographics
NPI:1457545543
Name:OUR LADY OF BELLEFONTE HOSPITAL, INC.
Entity Type:Organization
Organization Name:OUR LADY OF BELLEFONTE HOSPITAL, INC.
Other - Org Name:BELLEFONTE WOUND CARE 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:606-833-4043
Mailing Address - Fax:
Practice Address - Street 1:1000 ASHLAND DR
Practice Address - Street 2:STE G1
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7084
Practice Address - Country:US
Practice Address - Phone:606-833-4043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2843114Medicaid
KY000000551175OtherANTHEM BCBS
KY7100023550Medicaid
OH2843114Medicaid
KY00426Medicare PIN