Basic Information
| Provider Information | |||||||||
| NPI: | 1720292691 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELK REGIONAL PROFESSIONAL GROUP, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ERPG COMPREHENSIVE CARE LAB | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 763 JOHNSONBURG RD | ||||||||
| Address2: | |||||||||
| City: | SAINT MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158573417 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888456 | ||||||||
| FaxNumber: | 8147727278 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 METOXET STREET | ||||||||
| Address2: | |||||||||
| City: | RIDGWAY | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158531932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147885456 | ||||||||
| FaxNumber: | 8147727278 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OLSZEWSKI | ||||||||
| AuthorizedOfficialFirstName: | RITA | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8147888580 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | V | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 291U00000X | 029087 | PA | Y | Laboratories | Clinical Medical Laboratory |
No ID Information.