MEDICARE: DUBOIS REGIONAL MEDICAL CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	332BX2000X	Oxygen Equipment & Supplies (DME)
2	333600000X	Pharmacy
3	163WD0400X	Diabetes Educator Registered Nurse
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
5	332BN1400X	Nursing Facility Supplies (DME)
6	332BC3200X	Customized Equipment (DME)
7	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PP412367L	OTHER	PA	LICENSE
3	2080904	OTHER		PK

General Provider Information

NPI Number	:	1275527814
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUBOIS REGIONAL MEDICAL CENTER

Provider Business Mailing Address
First Line	:	100 HOSPITAL AVE
Second Line	:
City	:	DU BOIS
State	:	PA
Zip	:	15801-1440
Country	:	US
Telephone Number	:	814-834-3017
Fax Number	:	814-834-1031

Provider Business Practice Location Address
First Line	:	765 JOHNSONBURG RD
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-3417
Country	:	US
Telephone Number	:	814-834-3017
Fax Number	:	814-834-1031

Authorized Official
Title or Position	:	CFO/AUTHORIZED OFFICIAL
Name	:	BRIAN S KLINE
Credential	:
Telephone Number	:	814-375-6377

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	12/10/2025

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Directions to “DUBOIS REGIONAL MEDICAL CENTER ” Practice Location

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