Provider Demographics
NPI:1366439580
Name:ELK REGIONAL PROFESSIONAL GROUP, INC
Entity Type:Organization
Organization Name:ELK REGIONAL PROFESSIONAL GROUP, INC
Other - Org Name:ERPG PLATT FAMILY PRACTICE
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT, ERPG
Authorized Official - Prefix:
Authorized Official - First Name:RITA
Authorized Official - Middle Name:V
Authorized Official - Last Name:OLSZEWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-788-8580
Mailing Address - Street 1:111 COBB ST
Mailing Address - Street 2:
Mailing Address - City:JOHNSONBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15845-1209
Mailing Address - Country:US
Mailing Address - Phone:814-965-2857
Mailing Address - Fax:814-965-2523
Practice Address - Street 1:111 COBB ST
Practice Address - Street 2:
Practice Address - City:JOHNSONBURG
Practice Address - State:PA
Practice Address - Zip Code:15845-1209
Practice Address - Country:US
Practice Address - Phone:814-965-2857
Practice Address - Fax:814-965-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018592850042Medicaid
PA0018592850039Medicaid
PACH8032OtherRRM
PA1738937OtherHIGHMARK ASSIGNMENT
PACH8032OtherRRM