Healthcare Provider Details

I. General information

NPI: 1164496873
Provider Name (Legal Business Name): EVANS ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR USA MEDDAC, EVANS ARMY COMMUNITY HOSPITAL/SWS
FT CARSON CO
80913-4603
US

IV. Provider business mailing address

1650 COCHRANE CIR
FT CARSON CO
80913-4603
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-4585
  • Fax: 719-526-0608
Mailing address:
  • Phone: 719-526-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number989779
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. VICTORIA LYNN PEARLSTEIN
Title or Position: SOCIAL WORKER
Credential: MSW, LCSW
Phone: 719-526-5332