Basic Information
| Provider Information | |||||||||
| NPI: | 1821079450 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELK REGIONAL PROFESSIONAL GROUP, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ERPG CRNA SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | ERPG CRNA SERVICES | ||||||||
| Address2: | 763 JOHNSONBURG ROAD | ||||||||
| City: | ST. MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888580 | ||||||||
| FaxNumber: | 8147888092 | ||||||||
| Practice Location | |||||||||
| Address1: | ERPG CRNA SERVICES | ||||||||
| Address2: | 763 JOHNSONBURG ROAD | ||||||||
| City: | ST. MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15857 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888580 | ||||||||
| FaxNumber: | 8147888092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OLSZEWSKI | ||||||||
| AuthorizedOfficialFirstName: | RITA | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, ERPG | ||||||||
| AuthorizedOfficialTelephone: | 8147888580 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.