NPIMap

Organization Active NPI

Elk Regional Professional Group, Inc.

  • Clinical Medical Laboratory
  • Johnsonburg, PA
National Provider Identifier
1477767036
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
029511 Issued in PA
Legal business name
ELK REGIONAL PROFESSIONAL GROUP, INC.
Practice address
111 Cobb St
Johnsonburg, PA 15845-1209
Phone
(814) 965-2857
Fax
(814) 965-2523
NPI assigned
May 10, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Ms. Rita V Olszewski
Title
Administrator
Phone
(814) 788-8580

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 029511 PA Primary

Addresses

Primary practice location

111 Cobb St
Johnsonburg, PA 15845-1209

Mailing address

763 Johnsonburg Rd
Saint Marys, PA 15857-3417
Phone (814) 965-2857

Other identifiers 1

IdentifierTypeStateIssuer
0018592850042MedicaidPA

Other names 1

  • ERPG Platt Family Practice Lab - Johnsonburg Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
39D2160082RHC - Johnsonburg111 Cobb Street, Johnsonburg, PA 15845Certificate of waiverJan 3, 2027

National Provider Directory

National Provider Directory
Tax ID family
Elk Regional Professional Group Inc35 organizations share this tax ID, including this one

Other organizations with this tax ID 34

Organizations that report the same tax identification number in the National Provider Directory.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178755200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1477767036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 JOHNSONBURG RD",
            "city": "SAINT MARYS",
            "state": "PA",
            "postal_code": "158573417",
            "telephone_number": "814-965-2857",
            "fax_number": "814-965-2523"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 COBB ST",
            "city": "JOHNSONBURG",
            "state": "PA",
            "postal_code": "158451209",
            "telephone_number": "814-965-2857",
            "fax_number": "814-965-2523"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELK REGIONAL PROFESSIONAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "OLSZEWSKI",
        "authorized_official_first_name": "RITA",
        "authorized_official_middle_name": "V",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "814-788-8580",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "029511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0018592850042",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ERPG Platt Family Practice Lab - Johnsonburg",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Johnsonburg, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.