MEDICARE: ELK REGIONAL PROFESSIONAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	291U00000X	Clinical Medical Laboratory	028358	PA

General Provider Information

NPI Number	:	1831393214
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELK REGIONAL PROFESSIONAL GROUP, INC.

Provider Business Mailing Address
First Line	:	763 JOHNSONBURG RD
Second Line	:
City	:	SAINT MARYS
State	:	PA
Zip	:	15857-3417
Country	:	US
Telephone Number	:	814-788-8580
Fax Number	:	814-788-8402

Provider Business Practice Location Address
First Line	:	514 MARKET ST
Second Line	:
City	:	JOHNSONBURG
State	:	PA
Zip	:	15845-1240
Country	:	US
Telephone Number	:	814-781-7531
Fax Number	:	814-781-7494

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RITA V OLSZEWSKI
Credential	:
Telephone Number	:	814-788-8580

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	08/22/2020

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