Healthcare Provider Details

I. General information

NPI: 1902821531
Provider Name (Legal Business Name): JOHN H. BISSELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 S CAREFREE CIR STE F
COLORADO SPRINGS CO
80917-3053
US

IV. Provider business mailing address

1605 N UNION BLVD
COLORADO SPRINGS CO
80909-2828
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-3764
  • Fax: 719-635-7593
Mailing address:
  • Phone: 719-635-3764
  • Fax: 719-635-7593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number27753
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: