NPIMap

Organization Active NPI

Richard T.C. Wan, M.D. ,PSC

  • Preferred Provider Organization
  • Morgantown, KY
National Provider Identifier
1104996776
Registry record updated Jun 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Preferred Provider OrganizationTaxonomy code 305R00000X
License
16599 Issued in KY
Legal business name
RICHARD T.C. WAN, M.D. ,PSC
Practice address
101 W Roberts St
Morgantown, KY 42261-7942
Phone
(270) 526-3841
Fax
(270) 526-2651
NPI assigned
Nov 9, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard TC Wan, MDNPI 1023116654
Title
Owner
Phone
(270) 526-3841

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Preferred Provider Organization 305R00000X 16599 KY Primary

Addresses

Primary practice location

101 W Roberts St
Morgantown, KY 42261-7942

Mailing address

PO Box 129
Morgantown, KY 42261-0129
Phone (270) 526-3841

Other identifiers 3

IdentifierTypeStateIssuer
65902033MedicaidKY
18DO326142OtherKYCLIA
000000045886OtherKYBCBS

Other names 1

  • Wan's Medical Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1104996776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 129",
            "city": "MORGANTOWN",
            "state": "KY",
            "postal_code": "422610129",
            "telephone_number": "270-526-3841",
            "fax_number": "270-526-2651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 W ROBERTS ST",
            "city": "MORGANTOWN",
            "state": "KY",
            "postal_code": "422617942",
            "telephone_number": "270-526-3841",
            "fax_number": "270-526-2651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD T.C. WAN, M.D. ,PSC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-09",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "WAN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "TC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-526-3841",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "305R00000X",
            "taxonomy_group": "",
            "desc": "Preferred Provider Organization",
            "state": "KY",
            "license": "16599",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "65902033",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "18DO326142",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000045886",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wan's Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Morgantown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.