Provider Demographics
NPI:1487874640
Name:ELK REGIONAL HEALTH CENTER, INC.
Entity type:Organization
Organization Name:ELK REGIONAL HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:YOUNT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-788-8615
Mailing Address - Street 1:763 JOHNSONBURG ROAD
Mailing Address - Street 2:ERHC MED EXPRESS
Mailing Address - City:ST. MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857
Mailing Address - Country:US
Mailing Address - Phone:814-788-8580
Mailing Address - Fax:814-788-8042
Practice Address - Street 1:104 METOXET STREET
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:PA
Practice Address - Zip Code:15853
Practice Address - Country:US
Practice Address - Phone:814-788-5555
Practice Address - Fax:814-788-5655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007292600030Medicaid
PA1007292600030Medicaid
PA390154Medicare Oscar/Certification