NPIMap

Organization Active NPI

Dubois Regional Med Ctr - Penn Highlands Q-Care/Family Med Emporium

Doing business as Penn Highlands DuBois

  • Family Medicine Physician
  • Emporium, PA
National Provider Identifier
1972988780
Registry record updated Feb 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
DUBOIS REGIONAL MED CTR - PENN HIGHLANDS Q-CARE/FAMILY MED EMPORIUM
Doing business as
Penn Highlands DuBois
Practice address
416 N Broad St
Emporium, PA 15834-1402
Phone
(814) 371-2200
NPI assigned
Jul 22, 2015
Last updated
Feb 29, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
PENN HIGHLANDS HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 29, 2016

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

Authorized official

Name
Mr. Brian S Kline
Title
VP/Cfo
Phone
(814) 375-6377

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X

Addresses

Primary practice location

416 N Broad St
Emporium, PA 15834-1402

Mailing address

100 Hospital Ave
Du Bois, PA 15801-1440
Phone (814) 371-2200

Other identifiers 1

IdentifierTypeStateIssuer
1007740880070MedicaidPA

Other names 1

  • Penn Highlands DuBois Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Du Bois Regional Med CT123 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 16

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

View all 16

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1437523200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456704000000",
    "number": "1972988780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 HOSPITAL AVE",
            "city": "DU BOIS",
            "state": "PA",
            "postal_code": "158011440",
            "telephone_number": "814-371-2200",
            "fax_number": "814-372-4232"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 N BROAD ST",
            "city": "EMPORIUM",
            "state": "PA",
            "postal_code": "158341402",
            "telephone_number": "814-371-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DUBOIS REGIONAL MED CTR - PENN HIGHLANDS Q-CARE/FAMILY MED EMPORIUM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PENN HIGHLANDS HEALTHCARE",
        "enumeration_date": "2015-07-22",
        "last_updated": "2016-02-29",
        "status": "A",
        "authorized_official_last_name": "KLINE",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "VP/CFO",
        "authorized_official_telephone_number": "814-375-6377",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1007740880070",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Penn Highlands DuBois",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Emporium, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.