Provider Demographics
NPI:1417284050
Name:WESTERN HEALTHCARE NETWORK
Entity Type:Organization
Organization Name:WESTERN HEALTHCARE NETWORK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:SISSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-339-7192
Mailing Address - Street 1:PO BOX 271160
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80527-1160
Mailing Address - Country:US
Mailing Address - Phone:303-339-7192
Mailing Address - Fax:970-416-9676
Practice Address - Street 1:2809 E HARMONY RD
Practice Address - Street 2:SUITE #100
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3109
Practice Address - Country:US
Practice Address - Phone:303-339-7192
Practice Address - Fax:970-416-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-03
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty