Healthcare Provider Details

I. General information

NPI: 1205823424
Provider Name (Legal Business Name): ELK REGIONAL PROFESSIONAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

761 JOHNSONBURG RD ERPG SPECIALTY SERVICES
SAINT MARYS PA
15857-3483
US

IV. Provider business mailing address

763 JOHNSONBURG RD ERPG SPECIALTY SERVICES
ST MARYS PA
15857-3417
US

V. Phone/Fax

Practice location:
  • Phone: 814-788-8615
  • Fax: 814-788-8092
Mailing address:
  • Phone: 814-788-8615
  • Fax: 814-788-8092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. RITA V OLSZEWSKI
Title or Position: VICE PRESIDENT, ERPG
Credential:
Phone: 814-788-8832