Healthcare Provider Details

I. General information

NPI: 1982668885
Provider Name (Legal Business Name): ELK REGIONAL PROFESSIONAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 METOXET STREET
RIDGWAY PA
15853
US

IV. Provider business mailing address

763 JOHNSONBURG RD
ST MARYS PA
15857-3417
US

V. Phone/Fax

Practice location:
  • Phone: 814-788-5456
  • Fax: 814-772-7278
Mailing address:
  • Phone: 814-788-8580
  • Fax: 814-788-8042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: RITA V OLSZEWSKI
Title or Position: ADMINISTRATOR
Credential:
Phone: 814-788-8580