Provider Demographics
NPI:1326114729
Name:HOLLY K RITCH MD PA
Entity Type:Organization
Organization Name:HOLLY K RITCH MD PA
Other - Org Name:LAKE COUNTY PREFERRED OBGYN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:RITCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-483-2229
Mailing Address - Street 1:PO BOX 1230
Mailing Address - Street 2:LAKE COUNTY PREFERRED OBGYN
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778
Mailing Address - Country:US
Mailing Address - Phone:352-483-2229
Mailing Address - Fax:352-483-4449
Practice Address - Street 1:6 NORTH EUSTIS STREET
Practice Address - Street 2:LAKE COUNTY PREFERRED OBGYN
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726
Practice Address - Country:US
Practice Address - Phone:352-483-2229
Practice Address - Fax:352-483-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83681207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G50082Medicare UPIN
15508Medicare ID - Type Unspecified