Organization
BELLEFONTE PHYSICIAN SERVICES, INC.
Active
Other names
Bellefonte Primary Care, South Shore
Organization subpart
No
Provider details
NPI number
Authorized official
TROY CONNETT (DIRECTOR OF FINANCE)
(606) 833-3333
Entity
Organization
Contact information
Practice address
US 23 AT INDIANOLA AVE., SOUTH SHORE, KY 41175
(606) 932-3150
Mailing address
PO BOX 2155, ASHLAND, KY 41105-2155
(606) 932-3150
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
363A00000X
Physician Assistant
—
—
Other
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
Enumeration date
11/21/2008
Last updated
05/20/2019
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