Organization
BELLEFONTE PHYSICIAN SERVICES, INC.
Active
Other names
Tri-State Pediatrics
Organization subpart
No
Provider details
NPI number
Authorized official
TROY CONNETT (DIRECTOR OF FINANCE)
(606) 833-3700
Entity
Organization
Contact information
Practice address
1000 ASHLAND DR STE 102, ASHLAND, KY 41101
(606) 836-0919
(606) 836-2847
Mailing address
PO BOX 2155, ASHLAND, KY 41105-2155
(606) 833-4922
(606) 833-3450
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000550494
ANTHEM BCBS
KY
05
—
2877892
—
OH
05
—
7100028510
—
KY
05
—
7100158620
—
KY
Enumeration date
01/22/2008
Last updated
05/20/2019
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