Organization
DUBOIS REGIONAL MEDICAL CENTER
Active
Parent organization
PENN HIGHLANDS HEALTHCARE
Other names
Penn Highlands Concussion Clinic
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENN HIGHLANDS HEALTHCARE
Authorized official
BRIAN S KLINE (VP/CFO/AUTHORIZED OFFICIAL)
(814) 375-6377
Entity
Organization
Contact information
Practice address
145 HOSPITAL AVE, SUITE 312, DU BOIS, PA 15801-1462
(814) 375-6200
Mailing address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(814) 375-6560
(814) 372-2848
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
PA
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100774088
—
PA
Enumeration date
03/20/2017
Last updated
04/05/2017
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