Healthcare Provider Details

I. General information

NPI: 1912374919
Provider Name (Legal Business Name): DUBOIS REGIONAL MEDICAL CENTER - PH INTERNAL MED CLEARFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2015
Last Update Date: 09/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 TURNPIKE AVE SUITE 220
CLEARFIELD PA
16830-1238
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-342-9701
  • Fax: 814-342-7056
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

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