Provider Demographics
NPI:1477767036
Name:ELK REGIONAL PROFESSIONAL GROUP, INC.
Entity Type:Organization
Organization Name:ELK REGIONAL PROFESSIONAL GROUP, INC.
Other - Org Name:ERPG PLATT FAMILY PRACTICE LAB - JOHNSONBURG
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
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 1:763 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:814-965-2857
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:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA029511291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018592850042Medicaid
PA065132 Q8NMedicare ID - Type Unspecified