NPIMap

Organization Active NPI

Dubois Regional Medical Center

Doing business as Brockway Drug Co

  • Community/Retail Pharmacy
  • Brockway, PA
National Provider Identifier
1710995071
Registry record updated Oct 13, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PP410257L Issued in PA
Legal business name
DUBOIS REGIONAL MEDICAL CENTER
Doing business as
Brockway Drug Co
Practice address
1365 Main St
Brockway, PA 15824-1635
Phone
(814) 268-3305
Fax
(814) 265-1143
NPI assigned
Aug 3, 2006
Last updated
Oct 13, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Michelle Bennett
Title
Director of Retail Pharmacy
Phone
(814) 299-7553

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X PP410257L PA
Community/Retail Pharmacy 3336C0003X PP410257L PA Primary

Addresses

Primary practice location

1365 Main St
Brockway, PA 15824-1635

Mailing address

1365 Main St
Brockway, PA 15824-1635
Phone (814) 268-3305

Other identifiers 2

IdentifierTypeStateIssuer
3915482OtherNABP NUMBER
0006339800002MedicaidPA

Other names 1

  • Brockway Drug Co Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20131120001672 PA Part B Supplier - Mass Immunization (Roster Biller Only) 6002935137 Practice locations: Brockway, PA
O20161228002214 PA Part B Supplier - Mass Immunization (Roster Biller Only) 5890689715 8 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Saint Marys, PA; Ridgway, PA; Reynoldsville, PA; Punxsutawney, PA; Clearfield, PA; Dubois, PA; Brockway, PA; Clarion, PA…
O20230109000811 PA DME Supplier - Pharmacy 5890689715 Practice locations: Brockway, PA

Other NPIs on the same Medicare enrollment 8

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Dubois Regional Medical Center1365 Main St, Brockway, PA 15824-1635(814) 268-3305 Epoetin|Immunosuppressive Drugs|Nebulizer Drugs|Oral Anticancer Drugs|Oral Antiemetic Drugs|Blood Glucose Monitors/Supplies (Non-Mail Order)|Ostomy Supplies|Nebulizer Equipment and/or Supplies|Surgical Dressings|Diabetic Shoes and Inserts|Diabetic Shoes/Inserts - Custom Accepts assignmentParticipating since Feb 9, 2019

National Provider Directory

National Provider Directory
Tax ID family
Dubois Regional Medical Center - Penn Highlands Dubois Medical Arts123 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

1365 Main St
Brockway, PA 15824
Phone (814) 268-3305

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Penn Highlands BrookvilleBrookville, PA, CCN 391312 Hospital Operational/Managerial Control Sep 26, 2007
Dr Arthur Clifton McKinley Health CenterBrookville, PA, CCN 395550 Skilled nursing facility 5% Or Greater Indirect Ownership Interest
Operational/Managerial Control
Adp of the SNF		 Dec 31, 2021
Jan 1, 2024
Sep 25, 2025
Penn Highlands Jefferson ManorBrookville, PA, CCN 395626 Skilled nursing facility 5% Or Greater Indirect Ownership Interest
Adp of the SNF		 Apr 1, 2019
Dec 9, 2025
Penn Highlands BrookvillePhilipsburg, PA, CCN 393430 Rural health clinic Operational/Managerial Control (100%) Oct 1, 2011

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1665619200000",
    "number": "1710995071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 MAIN ST",
            "city": "BROCKWAY",
            "state": "PA",
            "postal_code": "158241635",
            "telephone_number": "814-268-3305",
            "fax_number": "814-265-1143"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 MAIN ST",
            "city": "BROCKWAY",
            "state": "PA",
            "postal_code": "158241635",
            "telephone_number": "814-268-3305",
            "fax_number": "814-265-1143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBOIS REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-03",
        "last_updated": "2022-10-13",
        "certification_date": "2022-10-13",
        "status": "A",
        "authorized_official_last_name": "BENNETT",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_title_or_position": "DIRECTOR OF RETAIL PHARMACY",
        "authorized_official_telephone_number": "814-299-7553"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "PA",
            "license": "PP410257L",
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "PA",
            "license": "PP410257L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NABP NUMBER",
            "identifier": "3915482",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006339800002",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Brockway Drug Co",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brockway, PA

Sources for this page

Verify at the official NPI Registry.