Healthcare Provider Details

I. General information

NPI: 1487943809
Provider Name (Legal Business Name): DUBOIS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 03/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE BILLING DEPARTMENT
DU BOIS PA
15801-1440
US

IV. Provider business mailing address

100 HOSPITAL AVE BILLING DEPARTMENT
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3033
  • Fax: 814-372-2613
Mailing address:
  • Phone: 814-375-3033
  • Fax: 814-372-2613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOHN S SUTIKA
Title or Position: PRESIDENT
Credential:
Phone: 814-375-3385