Provider Demographics
NPI:1003843053
Name:RITCHEY, SARA JO (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SARA JO
Middle Name:
Last Name:RITCHEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA JO
Other - Middle Name:
Other - Last Name:ZUCHOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:22 WALNUT ST
Mailing Address - Street 2:LAUREL HEALTH CENTER ADMINISTRATION
Mailing Address - City:WELLSBORO
Mailing Address - State:PA
Mailing Address - Zip Code:16901-1526
Mailing Address - Country:US
Mailing Address - Phone:570-723-0500
Mailing Address - Fax:570-724-1197
Practice Address - Street 1:103 FORESTVIEW DRIVE
Practice Address - Street 2:ELKLAND LAUREL HEALTH CENTER
Practice Address - City:ELKLAND
Practice Address - State:PA
Practice Address - Zip Code:16920
Practice Address - Country:US
Practice Address - Phone:814-258-5117
Practice Address - Fax:814-258-5510
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052362363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100001172Medicaid
PA100001172Medicaid