Provider Demographics
NPI:1306373451
Name:ELK COUNTY EMS, LLC
Entity Type:Organization
Organization Name:ELK COUNTY EMS, LLC
Other - Org Name:ELK COUNTY AMBULANCE TRANSPORT SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHAUT
Authorized Official - Suffix:
Authorized Official - Credentials:PHRN
Authorized Official - Phone:814-594-7527
Mailing Address - Street 1:892 NEW CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:SLIPPERY ROCK
Mailing Address - State:PA
Mailing Address - Zip Code:16057-4228
Mailing Address - Country:US
Mailing Address - Phone:800-280-5974
Mailing Address - Fax:724-794-1633
Practice Address - Street 1:625 MAURUS ST STE D
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1037
Practice Address - Country:US
Practice Address - Phone:814-594-7527
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-20
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1033794150001Medicaid