| |
145 Hospital Ave Suite 205 Du Bois PA 15801-1462 | |
(814) 371-0373 | |
Not Available |
Full Name | |
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Speciality | Family Medicine |
Location | 145 Hospital Ave, Du Bois, Pennsylvania |
Authorized Official Name and Position | Brian Kline (CFO) |
Authorized Official Contact | 8143756377 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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100 Hospital Ave Business Office Du Bois PA 15801-1440 Ph: () - | 145 Hospital Ave Suite 205 Du Bois PA 15801-1462 Ph: (814) 371-0373 |
NPI Number | 1841675469 |
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Provider Enumeration Date | 07/24/2015 |
Last Update Date | 08/25/2015 |
Identifier | Type | State | Issuer |
---|---|---|---|
1841675469 | NPI | - | NPPES |
100774088 | Medicaid | PA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
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