Healthcare Provider Details

I. General information

NPI: 1841568169
Provider Name (Legal Business Name): EVANS ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2011
Last Update Date: 12/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 CODY DR
COLORADO SPRINGS CO
80911-1018
US

IV. Provider business mailing address

2400 CODY DR
COLORADO SPRINGS CO
80911-1018
US

V. Phone/Fax

Practice location:
  • Phone: 719-392-0737
  • Fax:
Mailing address:
  • Phone: 719-392-0737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number286500000X
License Number StateCO

VIII. Authorized Official

Name: DR. MARY DEIGHTON
Title or Position: PRIMARY CARE MANAGER
Credential: DO
Phone: 719-526-9277