Organization
RICHARD T.C. WAN, M.D. ,PSC
Active
Other names
Wan's Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD TC WAN MD (OWNER)
(270) 526-3841
Entity
Organization
Contact information
Practice address
101 W ROBERTS ST, MORGANTOWN, KY 42261-7942
(270) 526-3841
(270) 526-2651
Mailing address
PO BOX 129, MORGANTOWN, KY 42261-0129
(270) 526-3841
(270) 526-2651
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
16599
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000045886
BCBS
KY
01
—
18DO326142
CLIA
KY
05
—
65902033
—
KY
Enumeration date
11/09/2006
Last updated
06/18/2008
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