Provider Demographics
NPI:1932486149
Name:RUSH, SARA COLLEEN (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:COLLEEN
Last Name:RUSH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:COLLEEN
Other - Last Name:FLYNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:955 EASTWIND DR
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-3376
Mailing Address - Country:US
Mailing Address - Phone:614-262-9947
Mailing Address - Fax:614-268-7849
Practice Address - Street 1:2216 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BEXLEY
Practice Address - State:OH
Practice Address - Zip Code:43209-2319
Practice Address - Country:US
Practice Address - Phone:614-826-9266
Practice Address - Fax:614-826-9267
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003429363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH50.003429OtherMEDICAL LICENSE