1578589685 NPI number — BELLEFONTE PATHOLOGY AND LABORATORY MEDICINE PSC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578589685 NPI number — BELLEFONTE PATHOLOGY AND LABORATORY MEDICINE PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BELLEFONTE PATHOLOGY AND LABORATORY MEDICINE PSC
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:
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:
1578589685
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1629
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:
41105-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-458-8653
Provider Business Mailing Address Fax Number:
502-456-4440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 SAINT CHRISTOPHER DR
Provider Second Line Business Practice Location Address:
PATHOLOGY DEPT
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-833-3634
Provider Business Practice Location Address Fax Number:
606-836-9914
Provider Enumeration Date:
07/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORRIS
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
R
Authorized Official Title or Position:
LABORATORY MEDICAL DIRECTOR
Authorized Official Telephone Number:
606-833-3634

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 608673400 . This is a "WORKERS COMP FLORIDA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: DC8843 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 608673400 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100240980 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000355047 . This is a "ANTHEM BLUE CROSS BS" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50006256 . This is a "PASSPORT MEDICAID" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3810003731 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 608673400 . This is a "BLACK LUNG PROGRAM" identifier . This identifiers is of the category "OTHER".




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