Healthcare Provider Details

I. General information

NPI: 1639402274
Provider Name (Legal Business Name): EVANS ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
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

6818 SASSER DR APT A
COLORADO SPRINGS CO
80902-4340
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-5231
  • Fax:
Mailing address:
  • Phone: 719-559-5642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number678319
License Number StateTX

VIII. Authorized Official

Name: NICHOLAS PIANTANIDA
Title or Position: DCCS
Credential: M.D.
Phone: 719-526-5231