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	License Number State
1	207Q00000X	Family Medicine Physician	135501	PA

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	1728632	OTHER	PA	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1881614204
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	:	814-653-8222
Fax Number	:	814-653-9305

Provider Business Practice Location Address
First Line	:	5 N 3RD ST
Second Line	:
City	:	REYNOLDSVILLE
State	:	PA
Zip	:	15851-1231
Country	:	US
Telephone Number	:	814-653-8222
Fax Number	:	814-653-9305

Authorized Official
Title or Position	:	VP & CFO
Name	:	MR. BRIAN S KLINE
Credential	:
Telephone Number	:	814-375-6377

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	02/17/2014

Similar Medicare Providers

1417979253 — DUBOIS REGIONAL MEDICAL CENTER
Practice Location Address:

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

Practice Phone: 814-653-8222
Practice Fax: 814-653-9305

1750364733 — REYNOLDSVILLE AREA AMBULANCE SERVICE INC
Practice Location Address:

203 E MAIN ST
REYNOLDSVILLE, PA
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Practice Phone: 814-653-8746
Practice Fax: 814-653-8746

1508852088 — DR. RANDY WILLIAM MCCALL D.C.
Practice Location Address:

105 E MAIN ST
REYNOLDSVILLE, PA
15851-1244

Practice Phone: 814-653-9514
Practice Fax: 814-653-8842

1962465427 — SHALVA V KAKABADZE MD
Practice Location Address:

5 N 3RD ST
REYNOLDSVILLE, PA
15851-0907

Practice Phone: 814-653-8222
Practice Fax: 814-653-9305

1306809694 — DR. HARRY EUGENE KUNSELMAN DMD
Practice Location Address:

473 MAIN ST
REYNOLDSVILLE, PA
15851-1250

Practice Phone: 814-653-2227
Practice Fax: 814-653-2227

1124042270 — JENNIFER WINEBERG ZEITLER MD
Practice Location Address:

522 E MAIN ST
REYNOLDSVILLE, PA
15851-1328

Practice Phone: 814-653-8000
Practice Fax: 814-653-9632

Directions to “DUBOIS REGIONAL MEDICAL CENTER ” Practice Location

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