1922233147 NPI number — DUBOIS REGIONAL MEDICAL CENTER

Table of content: (NPI 1922233147)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922233147 NPI number — DUBOIS REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUBOIS REGIONAL MEDICAL CENTER
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:
6
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:
1922233147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 HOSPITAL AVENUE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DUBOIS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15801-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-375-4200
Provider Business Mailing Address Fax Number:
814-375-4232

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
90 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BROOKVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15825-1382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-849-1874
Provider Business Practice Location Address Fax Number:
814-849-1444
Provider Enumeration Date:
05/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KLINE
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
S
Authorized Official Title or Position:
AUTHORIZED OFFICIAL, VP, & CFO
Authorized Official Telephone Number:
814-375-6377

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1007740880169 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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