Healthcare Provider Details

I. General information

NPI: 1417979253
Provider Name (Legal Business Name): DUBOIS REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 N 3RD ST SUITE 1
REYNOLDSVILLE PA
15851-1231
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-653-8222
  • Fax: 814-653-9305
Mailing address:
  • Phone: 814-653-8222
  • Fax: 814-653-9305

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number135501
License Number StatePA

VIII. Authorized Official

Name: MS. PATRICIA A CRESSLEY
Title or Position: VP & CFO
Credential:
Phone: 814-375-6299