Organization
BELLEFONTE PHYSICIAN SERVICES, INC.
Active
Other names
Bellefonte Pediatrics Russell
Organization subpart
No
Provider details
NPI number
Authorized official
TROY CONNETT (DIRECTOR OF FINANCE)
(606) 833-3333
Entity
Organization
Contact information
Practice address
1061 KENWOOD DR, RUSSELL, KY 41169-1527
(606) 833-6750
Mailing address
PO BOX 2155, ASHLAND, KY 41105-2155
(606) 833-4922
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100222090
—
KY
Enumeration date
07/30/2012
Last updated
11/13/2018
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