Healthcare Provider Details

I. General information

NPI: 1699813170
Provider Name (Legal Business Name): ELK MOUNTAIN INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 COURT ST
REDDING CA
96001-1721
US

IV. Provider business mailing address

PO BOX 993974
REDDING CA
96099-3974
US

V. Phone/Fax

Practice location:
  • Phone: 530-305-8324
  • Fax:
Mailing address:
  • Phone: 530-305-8324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471C3401X
TaxonomyComputed Tomography Radiologic Technologist
License NumberRHT 66028
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2471N0900X
TaxonomyNuclear Medicine Technology Radiologic Technologist
License NumberRHN 1756
License Number StateCA

VIII. Authorized Official

Name: MR. JEFFERY KENNETH ERVIN
Title or Position: PRESIDENT
Credential: CNMT,NCT,PET
Phone: 530-305-8324