Provider Demographics
NPI:1821085044
Name:ELK REGIONAL PROFESSIONAL GROUP, INC
Entity Type:Organization
Organization Name:ELK REGIONAL PROFESSIONAL GROUP, INC
Other - Org Name:ERPG ORTHOPEDIC 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 1:761 JOHNSONBURG RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3483
Mailing Address - Country:US
Mailing Address - Phone:814-788-8188
Mailing Address - Fax:814-834-6291
Practice Address - Street 1:761 JOHNSONBURG RD
Practice Address - Street 2:SUITE 310
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3483
Practice Address - Country:US
Practice Address - Phone:814-788-8188
Practice Address - Fax:814-834-6291
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Not Answered2251E1300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistElectrophysiology, ClinicalGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1437510OtherHIGHMARK ASSIGNMENT
PA0018592850017Medicaid
PA068150 RLAMedicare ID - Type Unspecified