MEDICARE: WESTERN HEALTHCARE NETWORK

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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1417284050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WESTERN HEALTHCARE NETWORK

Provider Business Mailing Address
First Line	:	PO BOX 271160
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80527-1160
Country	:	US
Telephone Number	:	303-339-7192
Fax Number	:	970-416-9676

Provider Business Practice Location Address
First Line	:	2809 E HARMONY RD
Second Line	:	SUITE #100
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3109
Country	:	US
Telephone Number	:	303-339-7192
Fax Number	:	970-416-9676

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	CHARLES SISSON
Credential	:	M.D.
Telephone Number	:	303-339-7192

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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