MEDICARE: MR. SHANNON COLE WINN CPO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1744P3200X	Prosthetics Case Management	CPO02652	AZ

General Provider Information

NPI Number	:	1154338440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHANNON COLE WINN CPO

Provider Business Mailing Address
First Line	:	1075 S IDAHO RD
Second Line	:	SUITE 101
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85219-6496
Country	:	US
Telephone Number	:	480-982-3000
Fax Number	:	480-982-3103

Provider Business Practice Location Address
First Line	:	1075 S IDAHO RD
Second Line	:	SUITE 101
City	:	APACHE JUNCTION
State	:	AZ
Zip	:	85219-6496
Country	:	US
Telephone Number	:	480-982-3000
Fax Number	:	480-982-3103

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	03/06/2008

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