Basic Information
| Provider Information | |||||||||
| NPI: | 1508858168 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DUBOIS INTERNAL MEDICINE ASSOCIATES, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 145 HOSPITAL AVENUE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | DU BOIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158011464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143710373 | ||||||||
| FaxNumber: | 8143710359 | ||||||||
| Practice Location | |||||||||
| Address1: | 145 HOSPITAL AVENUE | ||||||||
| Address2: | SUITE 205 | ||||||||
| City: | DU BOIS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158011464 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8143710373 | ||||||||
| FaxNumber: | 8143710359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2005 | ||||||||
| LastUpdateDate: | 04/20/2008 | ||||||||
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| AuthorizedOfficialLastName: | SCERBO | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8143710373 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | CH7839 | 01 | PA | RR MEDICARE GROUP# | OTHER | W318 | 01 | PA | GEISINGER GROUP# | OTHER | 0013054830002 | 05 | PA | MEDICAID |