Organization
BELLEFONTE PHYSICIAN SERVICES, INC.
Active
Other names
Bellefonte Cosmetic and Reconstructive Surgery
Organization subpart
No
Provider details
NPI number
Authorized official
TROY CONNETT (DIRECTOR OF FINANCE)
(606) 833-3333
Entity
Organization
Contact information
Practice address
1000 ASHLAND DR, STE. 303, ASHLAND, KY 41101-7084
(606) 325-0753
(606) 325-0757
Mailing address
PO BOX 2155, ASHLAND, KY 41105-2155
(606) 325-0753
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000568862
ANTHEM BCBS
KY
05
—
2873270
—
OH
05
—
7100051130
—
KY
01
—
DN8303
RR MEDICARE
KY
Enumeration date
05/29/2008
Last updated
11/13/2018
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