Active NPI
Buck Jack, LLC
Doing business as Woven Care
- Occupational Therapist
- Colorado Springs, CO
National Provider Identifier
1427724947
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- Legal business name
- BUCK JACK, LLC
- Doing business as
- Woven Care
- Practice address
- 6845 Campus Dr
Colorado Springs, CO 80920-3107 - Phone
- (719) 597-0822
- Fax
- (719) 599-4606
- NPI assigned
- Aug 17, 2021
- Last updated
- Feb 28, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Tanner Denn
- Title
- Credentialing Specialist
- Phone
- (719) 428-1840
Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.
Specialties & licenses 6
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | |||
| Psychologist | 103T00000X | |||
| Behavior Technician | 106S00000X | |||
| Physical Therapist | 225100000X | |||
| Occupational Therapist | 225X00000X | Primary | ||
| Speech-Language Pathologist | 235Z00000X |
Addresses
Primary practice location
6845 Campus Dr
Colorado Springs, CO 80920-3107
Mailing address
2233 Academy PL Ste 200
Colorado Springs, CO 80909-1666
Phone (719) 597-0822
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9000195838 | Medicaid | CO |
Other names 1
- Woven Care
National Provider Directory
National Provider Directory- Tax ID family
- Buck Jack LLC
Organizations with this tax ID in the same state 24
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Locations
6845 Campus Dr
Colorado Springs, CO 80920
Phone (719) 247-1726
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Behavior Technician
- Colorado Springs, CO
- NPI 1336866565
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629158400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1709078400000",
"number": "1427724947",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2233 ACADEMY PL STE 200",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809091666",
"telephone_number": "719-597-0822",
"fax_number": "719-599-4606"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6845 CAMPUS DR",
"city": "COLORADO SPRINGS",
"state": "CO",
"postal_code": "809203107",
"telephone_number": "719-597-0822",
"fax_number": "719-599-4606"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BUCK JACK, LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-08-17",
"last_updated": "2024-02-28",
"certification_date": "2024-02-28",
"status": "A",
"authorized_official_last_name": "DENN",
"authorized_official_first_name": "TANNER",
"authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
"authorized_official_telephone_number": "719-428-1840"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physical Therapist",
"state": null,
"license": null,
"primary": false
},
{
"code": "225X00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Occupational Therapist",
"state": null,
"license": null,
"primary": true
},
{
"code": "235Z00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Speech-Language Pathologist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9000195838",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Woven Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Colorado Springs, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.