Healthcare Provider Details

I. General information

NPI: 1235239963
Provider Name (Legal Business Name): DUBOIS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 02/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-375-3286
  • Fax: 814-375-3384
Mailing address:
  • Phone: 814-375-3286
  • Fax: 814-375-3384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN S KLINE
Title or Position: VP & CFO
Credential:
Phone: 814-375-6377