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	License Number State
1	207L00000X	Anesthesiology Physician	PA
2	208100000X	Physical Medicine & Rehabilitation Physician	PA
3	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	PA
4	208VP0000X	Pain Medicine Physician	PA
5	208VP0014X	Interventional Pain Medicine Physician	PA
6	207LP2900X	Pain Medicine (Anesthesiology) Physician	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	535960	OTHER	PA	MC PTAN

General Provider Information

NPI Number	:	1457809840
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	:	814-375-6560
Fax Number	:	814-375-2848

Provider Business Practice Location Address
First Line	:	761 JOHNSONBURG RD STE 310
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-3480
Country	:	US
Telephone Number	:	814-788-8577
Fax Number	:	814-788-8541

Authorized Official
Title or Position	:	CFO/AUTH OFFICIAL
Name	:	HEATHER B SCHNEIDER
Credential	:
Telephone Number	:	814-375-6432

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	11/29/2022

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Directions to “DUBOIS REGIONAL MEDICAL CENTER ” Practice Location

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