Healthcare Provider Details

I. General information

NPI: 1003192428
Provider Name (Legal Business Name): US ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2011
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6582 MAGARATH STREET
FORT CARSON CO
80913
US

IV. Provider business mailing address

6582 MAGRATH AVE
FORT CARSON CO
80913-4277
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-3206
  • Fax:
Mailing address:
  • Phone: 719-526-3206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number4704192378
License Number StateMI

VIII. Authorized Official

Name: KIMBERLI JANE MATTHEWS
Title or Position: PUBLIC HEALTH NURSE
Credential:
Phone: 719-526-3206