Provider Demographics
NPI:1598970949
Name:DUBOIS REGIONAL MEDICAL GROUP, PC
Entity Type:Organization
Organization Name:DUBOIS REGIONAL MEDICAL GROUP, PC
Other - Org Name:NORTH CENTRAL CARDIOLOGY ASSOCIATES (NCCA)
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:SUTIKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-375-6104
Mailing Address - Street 1:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15851-0189
Mailing Address - Country:US
Mailing Address - Phone:814-653-8162
Mailing Address - Fax:
Practice Address - Street 1:807 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1240
Practice Address - Country:US
Practice Address - Phone:814-375-3711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100751931-0006Medicaid
PA100751931-0006Medicaid