Basic Information
| Provider Information | |||||||||
| NPI: | 1659307585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUR LADY OF BELLEFONTE HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2420 ARGILLITE ROAD SUITE B | ||||||||
| Address2: | |||||||||
| City: | FLATWOODS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068363900 | ||||||||
| FaxNumber: | 6068360205 | ||||||||
| Practice Location | |||||||||
| Address1: | 2420 ARGILLITE ROAD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | FLATWOODS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 41139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068363900 | ||||||||
| FaxNumber: | 6068360205 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | LOBACH | ||||||||
| AuthorizedOfficialFirstName: | AUGUSTINUS | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICAN | ||||||||
| AuthorizedOfficialTelephone: | 6068363900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 28383 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2304705 | 05 | OH | MEDICAID | 64063993 | 05 | KY | MEDICAID |