# BELLEFONTE PHYSICIAN SERVICES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Bellefonte Urological Associates
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932424033
- **Authorized official:** TROY CONNETT (DIRECTOR OF FINANCE)
- **Authorized official phone:** (606) 833-3333

## Contact information

- **Practice address:** 1000 ASHLAND DR, STE. 302, ASHLAND, KY 41101-7084
- **Practice address phone:** (606) 833-6235
- **Practice address fax:** (606) 833-4668
- **Mailing address:** PO BOX 2155, ASHLAND, KY 41105-2155
- **Mailing address phone:** (606) 833-4922
- **Mailing address fax:** (606) 833-4668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | — | NULL | Yes |
| 208800000X | Urology Physician | — | — | Yes |
| 363A00000X | Physician Assistant | — | NULL | — |
| 363A00000X | Physician Assistant | — | — | — |

## Other

- **Enumeration date:** 03/31/2010
- **Last updated:** 05/20/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000665198 | ANTHEM BCBS | KY |
| 05 | — | 3059354 | — | OH |
| 05 | — | 7100122770 | — | KY |
| 05 | — | 7100159670 | — | KY |
| 01 | — | DN8303 | RR MEDICARE | KY |