Active NPI
Buck Jack LLC
Doing business as The Shandy Clinic
- Psychologist
- Aurora, CO
National Provider Identifier
1871107995
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- Legal business name
- BUCK JACK LLC
- Doing business as
- The Shandy Clinic
- Practice address
- 3131 S Vaughn Way Ste 110
Aurora, CO 80014-3501 - Phone
- (303) 755-5534
- NPI assigned
- Sep 4, 2020
- Last updated
- Sep 4, 2020
- 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
- William Colt
- Title
- President
- Phone
- (713) 410-6889
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | Primary |
Addresses
Primary practice location
3131 S Vaughn Way Ste 110
Aurora, CO 80014-3501
Mailing address
685 Citadel Dr E Ste 580
Colorado Springs, CO 80909-5381
Phone (719) 597-0822
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9000181601 | Medicaid | CO |
Other names 1
- The Shandy Clinic
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599177600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1599177600000",
"number": "1871107995",
"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"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3131 S VAUGHN WAY STE 110",
"city": "AURORA",
"state": "CO",
"postal_code": "800143501",
"telephone_number": "303-755-5534"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "BUCK JACK LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-09-04",
"last_updated": "2020-09-04",
"certification_date": "2020-09-04",
"status": "A",
"authorized_official_last_name": "COLT",
"authorized_official_first_name": "WILLIAM",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "713-410-6889"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"desc": "Psychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9000181601",
"state": "CO"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "The Shandy Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Aurora, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 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.