Provider Demographics
| NPI: | 1144249657 |
|---|---|
| Name: | DUBOIS REGIONAL MEDICAL CENTER |
| Entity type: | Organization |
| Organization Name: | DUBOIS REGIONAL MEDICAL CENTER |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CFO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | HEATHER |
| Authorized Official - Middle Name: | BOLLINGER |
| Authorized Official - Last Name: | SCHNEIDER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 814-375-6432 |
| Mailing Address - Street 1: | 100 HOSPITAL AVE |
| Mailing Address - Street 2: | |
| Mailing Address - City: | DU BOIS |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 15801-1440 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 814-371-2200 |
| Mailing Address - Fax: | 814-375-4232 |
| Practice Address - Street 1: | 100 HOSPITAL AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | DU BOIS |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 15801-1440 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 814-371-2200 |
| Practice Address - Fax: | 814-375-4232 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | PENN HIGHLANDS HEALTHCARE |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2006-07-18 |
| Last Update Date: | 2024-05-07 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 207P00000X, 207RC0200X, 207RP1001X, 207RS0012X, 207ZP0102X, 2085R0001X, 2085R0202X, 208600000X, 208G00000X, 208M00000X, 261Q00000X, 363A00000X, 363L00000X | ||
| PA | 135501 | 282N00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 282N00000X | Hospitals | General Acute Care Hospital | Group - Multi-Specialty | |
| No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
| No | 207ZP0102X | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
| No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| PA | 0028 | Other | BLUE CROSS PROVIDER # |
| PA | 390086 | Other | PTAN |
| PA | 1007740880070 | Medicaid | |
| PA | 390086 | Medicare ID - Type Unspecified | |
| PA | 1007740880070 | Medicaid |
