Basic Information
| Provider Information | |||||||||
| NPI: | 1306907480 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OUR LADY BELLEFONTE HOSPITAL, INC | ||||||||
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| OtherOrganizationName: | BELLEFONTE PAIN MANAGEMENT AND REHABILITATION | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1150 SAINT CHRISTOPHER DR | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411017055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068330144 | ||||||||
| FaxNumber: | 6068330113 | ||||||||
| Practice Location | |||||||||
| Address1: | 1150 SAINT CHRISTOPHER DR | ||||||||
| Address2: | |||||||||
| City: | ASHLAND | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411017055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6068330144 | ||||||||
| FaxNumber: | 6068330113 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/13/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WILDE | ||||||||
| AuthorizedOfficialFirstName: | CHRIS | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6068330144 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 40015 | KY | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.