Provider Demographics
NPI:1184645970
Name:ELK REGIONAL PROFESSIONAL GROUP ANESTHESIA
Entity Type:Organization
Organization Name:ELK REGIONAL PROFESSIONAL GROUP ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:UPENDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:THAKER
Authorized Official - Suffix:
Authorized Official - Credentials:AK
Authorized Official - Phone:814-788-8000
Mailing Address - Street 1:763 JOHNSONBURG RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3417
Mailing Address - Country:US
Mailing Address - Phone:814-788-8000
Mailing Address - Fax:
Practice Address - Street 1:763 JOHNSONBURG RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3417
Practice Address - Country:US
Practice Address - Phone:814-788-8000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty