Organization
DUBOIS REGIONAL MEDICAL GROUP, PC
Active
Parent organization
PENN HIGHLANDS DUBOIS
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENN HIGHLANDS DUBOIS
Authorized official
JOHN S SUTIKA CPA (PRESIDENT)
(814) 375-3385
Entity
Organization
Contact information
Practice address
135 MIDWAY DRIVE, SUITE B, DU BOIS, PA 15801-3857
(814) 371-1771
(814) 371-4417
Mailing address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(814) 375-6560
(814) 372-2848
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
002564699
HIGHMARK ASSIGNMENT ACCOUNT
PA
05
—
100751931-0013
—
PA
Enumeration date
01/05/2011
Last updated
03/23/2015
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