Basic Information
| Provider Information | |||||||||
| NPI: | 1447287602 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUR LADY OF BELLEFONTE HOSPITAL, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 ARGILLITE ROAD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | FLATWOODS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411391972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068363900 | ||||||||
| FaxNumber: | 6068360205 | ||||||||
| Practice Location | |||||||||
| Address1: | 2420 ARGILLITE ROAD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | FLATWOODS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411391972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068363900 | ||||||||
| FaxNumber: | 6068360205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | THOMAS | ||||||||
| AuthorizedOfficialFirstName: | TRACEY | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 6068363900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | TP039 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | TP039 | 01 | KY | STATE LISCENSE NUMBER | OTHER |