1538324454 NPI number — BELLEFONTE PHYSICIAN SERVICES, INC

Table of content: (NPI 1538324454)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538324454 NPI number — BELLEFONTE PHYSICIAN SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLEFONTE PHYSICIAN SERVICES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538324454
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41105-2155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-833-4680
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1005 E RING RD
Provider Second Line Business Practice Location Address:
STE. 2
Provider Business Practice Location Address City Name:
IRONTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45638-9610
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-534-9830
Provider Business Practice Location Address Fax Number:
740-534-9832
Provider Enumeration Date:
07/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
CONNETT
Authorized Official First Name:
TROY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE
Authorized Official Telephone Number:
606-833-3333

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X , with the licence number: 002901 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000585216 . This is a "ANTHEM BCBS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100084940 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2868026 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100061740 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: DO3581 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com