Healthcare Provider Details

I. General information

NPI: 1700873197
Provider Name (Legal Business Name): ELK REGIONAL PROFESSIONAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 WASHINGTON ST
ST MARYS PA
15857-1349
US

IV. Provider business mailing address

177 WASHINGTON ST
ST MARYS PA
15857-1349
US

V. Phone/Fax

Practice location:
  • Phone: 814-781-7531
  • Fax: 814-781-7494
Mailing address:
  • Phone: 814-781-7531
  • Fax: 814-781-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RITA V OLSZEWSKI
Title or Position: VICE PRESIDENT, ERPG
Credential:
Phone: 814-788-8580