# BELLEFONTE PHYSICIAN SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bellefonte Primary Care, South Shore
- **Organization subpart:** No

## Provider details

- **NPI number:** 1740435445
- **Authorized official:** TROY CONNETT (DIRECTOR OF FINANCE)
- **Authorized official phone:** (606) 833-3333

## Contact information

- **Practice address:** US 23 AT INDIANOLA AVE., SOUTH SHORE, KY 41175
- **Practice address phone:** (606) 932-3150
- **Mailing address:** PO BOX 2155, ASHLAND, KY 41105-2155
- **Mailing address phone:** (606) 932-3150

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 11/21/2008
- **Last updated:** 05/20/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000598137 | ANTHEM BCBS | KY |
| 05 | — | 2914921 | — | OH |
| 05 | — | 7100068960 | — | KY |
| 01 | — | 7920801 | AETNA | KY |
| 01 | — | DN8303 | RR MEDICARE | KY |