Healthcare Provider Details

I. General information

NPI: 1275504599
Provider Name (Legal Business Name): EVANS ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FORT CARSON CO
80913-4603
US

IV. Provider business mailing address

4654 BALI CT
COLORADO SPRINGS CO
80911-3658
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7549
  • Fax:
Mailing address:
  • Phone: 719-391-8880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number051996
License Number StateNC

VIII. Authorized Official

Name: IRENE OLIVER
Title or Position: NCOIC DON/ICU
Credential:
Phone: 719-526-7549