Organization
DUBOIS REGIONAL MEDICAL CENTER
Active
Parent organization
PENN HIGHLANDS HEALTHCARE
Other names
Penn Highlands Family Medicine - Kakabadze
Organization subpart
Yes
Provider details
NPI number
Legal business name
PENN HIGHLANDS HEALTHCARE
Authorized official
MR. BRIAN S KLINE (VP & CFO)
(814) 375-6377
Entity
Organization
Contact information
Practice address
5 N 3RD ST, REYNOLDSVILLE, PA 15851-1231
(814) 653-8222
(814) 653-9305
Mailing address
100 HOSPITAL AVE, DU BOIS, PA 15801-1440
(814) 653-8222
(814) 653-9305
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
135501
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1007740880083
—
PA
01
—
1728632
BLUE CROSS/BLUE SHIELD
PA
Enumeration date
07/20/2006
Last updated
02/17/2014
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