Provider Demographics
NPI:1215982871
Name:BELLEFONTE EERGENCY MEDICAL SPECIALISTS, PSC
Entity type:Organization
Organization Name:BELLEFONTE EERGENCY MEDICAL SPECIALISTS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANHOOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-833-3333
Mailing Address - Street 1:1000 SAINT CHRISTOPHER DR
Mailing Address - Street 2:EMERGENCY DEPARTMENT
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7034
Mailing Address - Country:US
Mailing Address - Phone:606-833-3333
Mailing Address - Fax:260-407-8004
Practice Address - Street 1:1000 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7034
Practice Address - Country:US
Practice Address - Phone:606-833-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146D00000XEmergency Medical Service ProvidersPersonal Emergency Response AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYPENDINGMedicaid
OH2649094Medicaid
OH2649094Medicaid