1003843053 NPI number — MS. SARA JO RITCHEY PA-C

Table of content: MS. SARA JO RITCHEY PA-C (NPI 1003843053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003843053 NPI number — MS. SARA JO RITCHEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RITCHEY
Provider First Name:
SARA JO
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ZUCHOWSKI
Provider Other First Name:
SARA JO
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003843053
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 WALNUT ST
Provider Second Line Business Mailing Address:
LAUREL HEALTH CENTER ADMINISTRATION
Provider Business Mailing Address City Name:
WELLSBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
16901-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
570-723-0500
Provider Business Mailing Address Fax Number:
570-724-1197

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 FORESTVIEW DRIVE
Provider Second Line Business Practice Location Address:
ELKLAND LAUREL HEALTH CENTER
Provider Business Practice Location Address City Name:
ELKLAND
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-258-5117
Provider Business Practice Location Address Fax Number:
814-258-5510
Provider Enumeration Date:
06/26/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  MA052362 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100001172 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".