Healthcare Provider Details

I. General information

NPI: 1194100719
Provider Name (Legal Business Name): DUBOIS REGIONAL MEDICAL CENTER - PENN HIGHLANDS FAMILY MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 MILLION DOLLAR HWY
SAINT MARYS PA
15857-2728
US

IV. Provider business mailing address

100 HOSPITAL AVE
DU BOIS PA
15801-1440
US

V. Phone/Fax

Practice location:
  • Phone: 814-781-6758
  • Fax:
Mailing address:
  • Phone: 814-375-4200
  • Fax: 814-375-4232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

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