Basic Information
| Provider Information | |||||||||
| NPI: | 1346625795 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BELLEFONTE PHYSICIAN SERVICES, INC. | ||||||||
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| OtherOrganizationName: | BELLEFONTE PRIMARY CARE, WHEELERSBURG | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2155 | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411052155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068334922 | ||||||||
| FaxNumber: | 6068334668 | ||||||||
| Practice Location | |||||||||
| Address1: | 8991 OHIO RIVER RD | ||||||||
| Address2: | STE. 2 | ||||||||
| City: | WHEELERSBURG | ||||||||
| State: | OH | ||||||||
| PostalCode: | 456941923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7409813356 | ||||||||
| FaxNumber: | 7405746910 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2015 | ||||||||
| LastUpdateDate: | 05/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | CONNETT | ||||||||
| AuthorizedOfficialFirstName: | TROY | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 6068333333 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 12922 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.