Healthcare Provider Details

I. General information

NPI: 1427433606
Provider Name (Legal Business Name): DRMC - PENN HIGHLANDS FAMILY MED CLEARFIELD 93230
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531A HANNAH ST
CLEARFIELD PA
16830-1209
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-765-2261
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRIAN KLINE
Title or Position: CFO
Credential:
Phone: 814-375-6377