The Shandy Clinic

LBN: Buck Jack Llc
The Shandy Clinic is an health care organization with primary practice located at 6190 Barnes Rd , Colorado Springs CO 80922-2600. The organization recently has 5 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Behavioral Analyst, Behavioral Health & Social Service Providers / Psychologist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist, Speech, Language and Hearing Service Providers / Speech-Language Pathologist. Speech, Language and Hearing Service Providers / Speech-Language Pathologist is the primary health care specialty. Buck Jack Llc can be contacted via phone (719) 247-1511, or through Colt, William via phone (713) 410-6889.

Contact Information

Primary practice address
6190 Barnes Rd Colorado Springs CO 80922-2600
Phone: (719) 247-1511
Fax: (719) 599-4606
Website:
Map and Directions
Authorized official contact:
Name: Colt, William
Phone: (713) 410-6889

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X
Behavioral Health & Social Service Providers / Psychologist 103T00000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Occupational Therapist 225X00000X
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X

Profile Details

NPI number 1215548425
LBN Legal business name Buck Jack Llc
DBA Doing business as The Shandy Clinic
Authorized official Colt, William
Entity Organization
Organization subpart 1 No
Enumeration date Aug 11th, 2020
Last updated Oct 1st, 2020 - about 6 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215548425 NPPES
Colorado MEDICAID 9000181601

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