Provider Demographics
NPI:1346290533
Name:DUBOIS MEDICAL SUPPLY COMPANY, INC.
Entity Type:Organization
Organization Name:DUBOIS MEDICAL SUPPLY COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:K
Authorized Official - Last Name:REZK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-375-1100
Mailing Address - Street 1:PO BOX 263
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0263
Mailing Address - Country:US
Mailing Address - Phone:814-375-1100
Mailing Address - Fax:814-375-9796
Practice Address - Street 1:320 LIBERTY BLVD
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2406
Practice Address - Country:US
Practice Address - Phone:814-375-1100
Practice Address - Fax:814-375-9796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007374400019Medicaid
PA1007374400019Medicaid