Provider Demographics
NPI:1962544627
Name:ROMELLE A BELMONTE, MD, LLC
Entity type:Organization
Organization Name:ROMELLE A BELMONTE, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROMELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELMONTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-402-4790
Mailing Address - Street 1:PO BOX 15711
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-0711
Mailing Address - Country:US
Mailing Address - Phone:812-402-4790
Mailing Address - Fax:812-402-4794
Practice Address - Street 1:350 W COLUMBIA ST
Practice Address - Street 2:SUITE 350
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1782
Practice Address - Country:US
Practice Address - Phone:812-402-4790
Practice Address - Fax:812-402-4794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01044467A207R00000X, 207RI0200X
KY31177207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000499139OtherBCBS PROVIDER PIN
IN200071730BMedicaid
INDF4494OtherMEDICARE RR
KY64882129Medicaid
KY64882129Medicaid
INDF4494OtherMEDICARE RR
IN247840Medicare PIN