Healthcare Provider Details

I. General information

NPI: 1487874640
Provider Name (Legal Business Name): ELK REGIONAL HEALTH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 09/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 METOXET STREET
RIDGWAY PA
15853
US

IV. Provider business mailing address

763 JOHNSONBURG ROAD ERHC MED EXPRESS
ST. MARYS PA
15857
US

V. Phone/Fax

Practice location:
  • Phone: 814-788-5555
  • Fax: 814-788-5655
Mailing address:
  • Phone: 814-788-8580
  • Fax: 814-788-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMIE L YOUNT
Title or Position: ADMINISTRATOR
Credential:
Phone: 814-788-8615