Provider Demographics
NPI:1669776795
Name:OUR LADY OF BELLEFONTE HOSPITAL INC
Entity type:Organization
Organization Name:OUR LADY OF BELLEFONTE HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:HALTER
Authorized Official - Suffix:
Authorized Official - Credentials:FACHE
Authorized Official - Phone:606-833-3600
Mailing Address - Street 1:1000 SAINT CHRISTOPHER DR
Mailing Address - Street 2:
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:606-833-3998
Practice Address - Street 1:118 SAINT CHRISTOPHER DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7016
Practice Address - Country:US
Practice Address - Phone:606-833-6241
Practice Address - Fax:606-833-3998
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUR LADY OF BELLEFONTE HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-04
Last Update Date:2017-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100212190Medicaid
OH0065104Medicaid
OH0065104Medicaid