Provider Demographics
NPI:1760563662
Name:DUBOIS REGIONAL MEDICAL CENTER
Entity Type:Organization
Organization Name:DUBOIS REGIONAL MEDICAL CENTER
Other - Org Name:DRMC SURGICAL PRACTICE - EAST
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
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 447
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-0447
Mailing Address - Country:US
Mailing Address - Phone:814-371-0240
Mailing Address - Fax:814-371-0281
Practice Address - Street 1:635 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2376
Practice Address - Country:US
Practice Address - Phone:814-371-0240
Practice Address - Fax:814-371-0281
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DUBOIS REGIONAL MED CTR
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-18
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty