Healthcare Provider Details

I. General information

NPI: 1497795702
Provider Name (Legal Business Name): ACH EVANS-CARSON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR BLDG 7500 ATTN: TREASURER'S OFFICE
FT CARSON CO
80913-4603
US

IV. Provider business mailing address

1650 COCHRANE CIR BLDG 7500
FT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7000
  • Fax:
Mailing address:
  • Phone: 800-642-6700
  • Fax: 719-526-7247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1101X
TaxonomyMilitary and U.S. Coast Guard Ambulatory Procedure Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. ELIZABETH MARGARITA MARIA BURLINGAME
Title or Position: CHIEF, UNIFORM BUSINESS OFFICE
Credential:
Phone: 719-526-7291