Healthcare Provider Details

I. General information

NPI: 1922233147
Provider Name (Legal Business Name): DUBOIS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 04/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 HOSPITAL RD SUITE 200
BROOKVILLE PA
15825-1382
US

IV. Provider business mailing address

100 HOSPITAL AVENUE
DUBOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-849-1874
  • Fax: 814-849-1444
Mailing address:
  • Phone: 814-375-4200
  • Fax: 814-375-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StatePA

VIII. Authorized Official

Name: BRIAN S KLINE
Title or Position: AUTHORIZED OFFICIAL, VP, & CFO
Credential:
Phone: 814-375-6377