1811191208 NPI number — DUBOIS REGIONAL MEDICAL GROUP PC

Table of content: (NPI 1811191208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811191208 NPI number — DUBOIS REGIONAL MEDICAL GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUBOIS REGIONAL MEDICAL GROUP PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811191208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REYNOLDSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15851-1282
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-653-8162
Provider Business Mailing Address Fax Number:
814-653-8164

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1049 N FRONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILIPSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16866-8258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-768-8888
Provider Business Practice Location Address Fax Number:
814-768-9444
Provider Enumeration Date:
06/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SUTIKA
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP & CFO
Authorized Official Telephone Number:
814-375-6104

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com