Provider Demographics
NPI:1790772184
Name:ELK REGIONAL PROFESSIONAL GROUP, INC.
Entity Type:Organization
Organization Name:ELK REGIONAL PROFESSIONAL GROUP, INC.
Other - Org Name:ERPG INTERNAL MEDICINE SERVICES
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 1:763 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:814-788-8580
Mailing Address - Fax:814-888-8042
Practice Address - Street 1:275 E 4TH ST
Practice Address - Street 2:
Practice Address - City:EMPORIUM
Practice Address - State:PA
Practice Address - Zip Code:15834-1411
Practice Address - Country:US
Practice Address - Phone:814-486-1785
Practice Address - Fax:814-486-3111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Not Answered207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1759558OtherHIGHMARK ASSIGNMENT
PA0018592850001Medicaid
PA0018592850001Medicaid