Provider Demographics
NPI:1891782025
Name:ELK REGIONAL PROFESSIONAL GROUP, INC
Entity Type:Organization
Organization Name:ELK REGIONAL PROFESSIONAL GROUP, INC
Other - Org Name:ERPG PATHOLOGY SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:BUSINESS ADMINSITRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-788-8615
Mailing Address - Street 1:763 JOHNSONBURG RD
Mailing Address - Street 2:
Mailing Address - City:ST MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-3417
Mailing Address - Country:US
Mailing Address - Phone:814-788-8179
Mailing Address - Fax:814-788-8039
Practice Address - Street 1:763 JOHNSONBURG RD
Practice Address - Street 2:
Practice Address - City:ST MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3417
Practice Address - Country:US
Practice Address - Phone:814-788-8179
Practice Address - Fax:814-788-8039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1430512OtherHIGHMARK ASSIGNMENT
PA0018592850037Medicaid
PA0018592850037Medicaid