Organization
ELK EMERGENCY GROUP PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SYLVAN M WALLER MD (PRESIDENT)
(800) 893-9698
Entity
Organization
Contact information
Practice address
763 JOHNSONBURG RD, SAINT MARYS, PA 15857-3417
(800) 893-9698
Mailing address
200 CORPORATE BLVD, SUITE 201, LAFAYETTE, LA 70508-3870
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Enumeration date
10/15/2013
Last updated
10/15/2013
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