NPIMap

Organization Active NPI

Buck Jack LLC

  • Occupational Therapist
  • Colorado Springs, CO
National Provider Identifier
1568060754
Registry record updated Oct 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
Legal business name
BUCK JACK LLC
Practice address
830 Tenderfoot Hill Rd Ste 100
Colorado Springs, CO 80906-7372
Phone
(719) 597-0822
Fax
(719) 599-4606
NPI assigned
Oct 12, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2020

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

Authorized official

Name
Rebecca Newman
Title
Billing Manager
Phone
(719) 597-0822

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior AnalystGroup: 193200000X MULTI-SPECIALTY GROUP 103K00000X
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X
Physical TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225100000X
Occupational TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 225X00000X Primary
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X

Addresses

Primary practice location

830 Tenderfoot Hill Rd Ste 100
Colorado Springs, CO 80906-7372

Mailing address

685 Citadel Dr E Ste 580
Colorado Springs, CO 80909-5381
Phone (719) 597-0822

Other names 1

  • THE SHANDY CLINIC Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Buck Jack LLC70 organizations share this tax ID, including this one

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.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1602460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602460800000",
    "number": "1568060754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "685 CITADEL DR E STE 580",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809095381",
            "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": "830 TENDERFOOT HILL RD STE 100",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809067372",
            "telephone_number": "719-597-0822",
            "fax_number": "719-599-4606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCK JACK LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-12",
        "last_updated": "2020-10-12",
        "certification_date": "2020-10-06",
        "status": "A",
        "authorized_official_last_name": "NEWMAN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "719-597-0822"
    },
    "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": "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE SHANDY CLINIC",
            "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 Oct 12, 2020; 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.