Basic Information
| Provider Information | |||||||||
| NPI: | 1821085044 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELK REGIONAL PROFESSIONAL GROUP, INC | ||||||||
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| OtherOrganizationName: | ERPG ORTHOPEDIC SERVICES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 761 JOHNSONBURG RD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ST MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158573483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888188 | ||||||||
| FaxNumber: | 8148346291 | ||||||||
| Practice Location | |||||||||
| Address1: | 761 JOHNSONBURG RD | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | ST MARYS | ||||||||
| State: | PA | ||||||||
| PostalCode: | 158573483 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8147888188 | ||||||||
| FaxNumber: | 8148346291 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | OLSZEWSKI | ||||||||
| AuthorizedOfficialFirstName: | RITA | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT, ERPG | ||||||||
| AuthorizedOfficialTelephone: | 8147888580 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 2251E1300X | X | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Electrophysiology, Clinical | 207X00000X | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 363L00000X | X | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 1437510 | 01 | PA | HIGHMARK ASSIGNMENT | OTHER | 0018592850017 | 05 | PA | MEDICAID |