COLBY WANG, MD, LLC (NPI# 1225463136) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1225463136 |
| Entity Type | Organization |
| Organization Name | COLBY WANG, MD, LLC |
| Other Organization Name | PREVENTATIVE PSYCHIATRY |
| Practice Address |
636 W Republic Rd B-112 Springfield MO 65807-5818 |
| Practice Telephone | 4178866067 |
| Mailing Telephone | 4178866067 |
| Mailing Fax Number | 4178864035 |
| Enumeration Date | 2013-09-10 |
| Last Update Date | 2013-09-10 |
| Authorized Official Name | COLBY L WANG (MD) |
| Authorized Official Telephone | 4178866067 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QM0855X |
Clinic/Center Specialization: Adolescent and Children Mental Health |
2001009509 | MO | Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Preventative Psychiatry | Other Name - Individual/Organization |
| Street Address |
636 W REPUBLIC RD B-112 |
| City | SPRINGFIELD |
| State | MO |
| Zip Code | 65807-5818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639153307 | Kort W Harshman | Chiropractor | 636 W Republic Rd, Suite 108, Springfield, MO 65807-5803 | 2005-12-06 |
| 1508169756 | Center of Change, L.L.C. | Psychologist | 636 W Republic Rd, C116, Springfield, MO 65807-5818 | 2010-12-09 |
| 1508023367 | Bryan Michael Dame | Chiropractor | 636 W Republic Rd, Ste 108, Springfield, MO 65807-5818 | 2008-05-20 |
| 1427226091 | Harshman Chiropractic Clinic LLC | Chiropractor | 636 W Republic Rd, Suite 108, Springfield, MO 65807-5803 | 2008-02-15 |
| 1972706489 | Tricia Lynn Bremer | Counselor | 636 W Republic Rd, C116, Springfield, MO 65807-5818 | 2007-06-11 |
| 1659485100 | Aaron Richard Dannegger | Dentist | 636 W Republic Rd, Suite 120, Springfield, MO 65807-5818 | 2006-08-19 |
| 1821022252 | Michael James Koban | Chiropractor | 636 W Republic Rd, Suite 108, Springfield, MO 65807-5818 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396390241 | Karley Kassandra Murphy | Counselor | 3734 South Ave #c, Springfield, MO 65807 | 2019-08-07 |
| 1396203626 | Auvia L Logan | Dietitian, Registered | 3322 S. Campbell Ave. Suite Cc, Springfield, MO 65807 | 2019-03-05 |
| 1598250961 | Kathryn Barber | Nurse Practitioner | 3800 S National Ave Ste 700, Springfield, MO 65807 | 2018-06-27 |
| 1447764899 | Missouri Midwifery Service | Clinic/Center | 3840 South Avenue, Springfield, MO 65807 | 2017-11-21 |
| 1124530290 | Senior Living Management Group, LLC | Skilled Nursing Facility | 3705 S Jefferson Ave, Springfield, MO 65807 | 2017-10-30 |
| 1740663335 | Sarah E Kirk | Physical Therapist | 3545 S. National Ave, Springfield, MO 65807 | 2015-07-01 |
| 1750713335 | Amanda Ward | Nurse Practitioner | 2150 W Republic Rd Ste 112, Springfield, MO 65807 | 2013-08-06 |
| 1932531126 | Eugenia R Cortez | Counselor | 2124 Chesterfield Blvd., Springfield, MO 65807 | 2013-07-30 |
| 1962742866 | Missouri Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3045 W Republic St, Springfield, MO 65807 | 2013-03-01 |
| 1033462387 | Miguel Angel Medina | Physician Assistant | 1900 South Sunshine Ave., Springfield, MO 65807 | 2012-10-24 |
| Find all providers in zip 65807 | ||||
| Taxonomy Code | 261QM0855X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Adolescent and Children Mental Health |
| An entity, facility, or distinct part of a facility providing diagnostic, treatment, and prescriptive services related to mental and behavioral disorders in children and adolescents. Services may be provided to parents and family members of the patient in the form of conjoint, group, or individual therapy, and education and/or training. |
| Notes: [7/1/2003: new] |
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|---|---|---|---|---|
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| 1851860209 | Preferred Family Healthcare, Inc | Clinic/Center | 3300 S National Ave Ste 500, Springfield, MO 65807-7343 | 2018-11-15 |
| 1982129722 | Solid Ground Counseling Services, LLC | Clinic/Center | 2515 W Allen Dr, Springfield, MO 65810-1300 | 2017-08-12 |
| 1568814390 | Self | Clinic/Center | 19 Merrick Ave Apt 1, Springfield, MA 01109-4324 | 2016-07-05 |
| 1538767090 | Camelot Care Centers, LLC | Clinic/Center | 2144 S Macarthur Blvd, Springfield, IL 62704-4502 | 2020-10-15 |
| 1609483049 | G Street Integrated Health | Clinic/Center | 1435 G St, Springfield, OR 97477-4113 | 2020-09-29 |
| 1174868442 | Ct- Family Care Services, LLC | Clinic/Center | 155 Maple St, Unit 204, Springfield, MA 01105-2649 | 2012-11-28 |
| 1922253947 | The Children's Center - Medical Services | Clinic/Center | 5220 S 6th Street Rd, Suite 2200, Springfield, IL 62703-5735 | 2008-11-18 |
| 1457505125 | Mental Health Centers of Central Illinois | Clinic/Center | 5220 S 6th Street Rd, Suite 2400, Springfield, IL 62703-5735 | 2008-11-07 |
| 1073706602 | Zoe Alison Burch | Clinic/Center | 15 E Pleasant St, Springfield, OH 45506-2201 | 2007-08-27 |
| Find all providers in SPRINGFIELD | ||||
| City | SPRINGFIELD |
| Zip Code | 65807 |
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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.