Basic Information
| Provider Information | |||||||||
| NPI: | 1023014842 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELK REGIONAL HEALTH CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 763 JOHNSONBURG RD | ||||||||
| Address2: | |||||||||
| City: | ST MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158573417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888000 | ||||||||
| FaxNumber: | 8147888234 | ||||||||
| Practice Location | |||||||||
| Address1: | 763 JOHNSONBURG RD | ||||||||
| Address2: | |||||||||
| City: | ST MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888000 | ||||||||
| FaxNumber: | 8147888234 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 08/22/2018 | ||||||||
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| AuthorizedOfficialLastName: | MACDONALD | ||||||||
| AuthorizedOfficialFirstName: | LAURIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHEIF FINANCIAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8147888743 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ELK REGIONAL HEALTH CENTER | ||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 010901 | PA | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 39M315 | 01 | PA | MEDICARE PTAN | OTHER |