RICHARD T.C. WAN, M.D. ,PSC (NPI# 1104996776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104996776 |
| Entity Type | Organization |
| Organization Name | RICHARD T.C. WAN, M.D. ,PSC |
| Other Organization Name | WAN'S MEDICAL CLINIC |
| Practice Address |
101 W Roberts St Morgantown KY 42261-7942 |
| Mailing Address |
Po Box 129 Morgantown KY 42261-0129 |
| Practice Telephone | 2705263841 |
| Practice Fax Number | 2705262651 |
| Mailing Telephone | 2705263841 |
| Mailing Fax Number | 2705262651 |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2008-06-18 |
| Authorized Official Name | RICHARD TC WAN (OWNER) |
| Authorized Official Telephone | 2705263841 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305R00000X | Preferred Provider Organization | 16599 | KY | Managed Care Organizations |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| KY | BCBS | 000000045886 | 01 |
| KY | 65902033 | 05 | |
| KY | CLIA | 18DO326142 | 01 |
| Other Name | Type Code |
|---|---|
| Wan's Medical Clinic | Doing Business As Name - Organization |
| Street Address |
101 W ROBERTS ST |
| City | MORGANTOWN |
| State | KY |
| Zip Code | 42261-7942 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023116654 | Richard T.c. Wan | Family Medicine | 101 W Roberts St, Morgantown, KY 42261-7942 | 2006-09-20 |
| 1942540018 | Lena M Gokey | Nurse Practitioner | 101 W Roberts St, Morgantown, KY 42261-7942 | 2013-02-26 |
| 1285888792 | Curtina Leigh Beliles | Physician Assistant | 101 W Roberts St, Morgantown, KY 42261-7942 | 2008-11-11 |
| 1629141817 | Shalini Chhabra | Internal Medicine | 101 W Roberts St, Morgantown, KY 42261-7942 | 2006-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629566500 | Kentucky Christian Recovery, LLC | Substance Abuse Rehabilitation Facility | 1118 S. Main St., Suite 3, Morgantown, KY 42261 | 2018-04-26 |
| 1437663846 | Ack Healthcare Management LLC | Nurse Practitioner | 1116 S Main St Ste 5, Morgantown, KY 42261 | 2017-11-21 |
| 1477076735 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 205 W Gl Smith St, Morgantown, KY 42261 | 2017-07-19 |
| 1194113720 | Hank S Washer | Pharmacist | 205 West Gl Smith Street, Morgantown, KY 42261 | 2015-01-06 |
| 1114330867 | Shannon Logan | Pharmacist | 205 West G. L. Smith Street, Morgantown, KY 42261 | 2014-06-10 |
| 1215227897 | Robert Henry Campbell | Pharmacist | 205 West G.l. Smith St., Morgantown, KY 42261 | 2011-04-15 |
| 1285924076 | Dale Ervin Beaty | Pharmacist | 205 West G L Smith Street, Morgantown, KY 42261 | 2011-04-13 |
| 1003121153 | Sharon J Douglas | Marriage & Family Therapist | 213 West Ohio St., Morgantown, KY 42261 | 2010-08-13 |
| 1750555033 | Burt & Jackson Dmd Pllc Bluegrass Oral Health Center of Morgantown | Dentist | 304 West Ohio St., Morgantown, KY 42261 | 2008-04-17 |
| 1619168994 | Lp Morgantown LLC | Durable Medical Equipment & Medical Supplies | 201 S Warren St, Morgantown, KY 42261 | 2007-08-05 |
| Find all providers in zip 42261 | ||||
| Taxonomy Code | 305R00000X |
| Grouping | Managed Care Organizations |
| Classification | Preferred Provider Organization |
| A group of physicians and/or hospitals who contract with an employer to provide services to their employees. In a PPO, the patient may got to the physician of his/her choice, even if that physician does not participate in the PPO, but the patient receives care at a lower benefit level. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/ October 1995, p. 62 |
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|---|---|---|---|---|
| 1073962874 | My Time Counseling Services for Professionals, P.l.l.c. | Preferred Provider Organization | 383 Sals Branch Rd, Evarts, KY 40828-6484 | 2016-06-13 |
| 1780096180 | Ez Tubz LLC | Preferred Provider Organization | 2207 Crums Ln, Louisville, KY 40216-4253 | 2014-05-20 |
| 1649317736 | Sunny Enterprise Inc | Preferred Provider Organization | 8700 Westport Rd # Su112, Louisville, KY 40242-3100 | 2007-01-30 |
| 1699842088 | Byers-abston Chiropractic, Psc | Preferred Provider Organization | 105 N. Lyndon Lane, Suite 102, Louisville, KY 40222-5550 | 2006-11-29 |
| 1043253925 | Bullitt County Family Care Center, Pllc | Preferred Provider Organization | 1578 Highway 44 East, Suite 2, Shepherdsville, KY 40165 | 2006-06-14 |
| 1831570399 | Loki Inc | Preferred Provider Organization | 10824 Us 23 South, Suite 102, Betsy Layne, KY 41605 | 2015-06-10 |
| 1558677377 | Dr James E Miller Psc | Preferred Provider Organization | 311 N 3rd St, Suite A, Richmond, KY 40475-1421 | 2010-08-31 |
| 1164661849 | Preferred Medical Bill Review LLC | Preferred Provider Organization | 309 Townepark Cir, Suite 100, Louisville, KY 40243-2333 | 2009-02-19 |
| 1629233911 | Anointed Touch Massage Therapy | Preferred Provider Organization | 934 Broadway St, Paducah, KY 42001-6810 | 2008-07-25 |
| 1013104470 | Radha Venkatramanan, Pllc | Preferred Provider Organization | 210 Burley Ave, Suite A, Hopkinsville, KY 42240-8725 | 2007-10-01 |
| Find all providers with the same taxonomy | ||||
| City | MORGANTOWN |
| Zip Code | 42261 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.