Healthcare Provider Details

I. General information

NPI: 1649248014
Provider Name (Legal Business Name): DEPARTMENT OF THE ARMY USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL OB/GYN CLINIC 1650 COCHRANE CIR
FT CARSON CO
80911
US

IV. Provider business mailing address

USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIRCLE OB/GYN CLINIC
FT CARSON CO
80911
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7439
  • Fax: 719-526-7850
Mailing address:
  • Phone: 719-526-7439
  • Fax: 719-526-7850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number150011
License Number StateCO

VIII. Authorized Official

Name: MS. TERRY LYNN BALL
Title or Position: R.N. OB/GYN CLINIC TRAIGE DEPARTMEN
Credential: REGISTERED NURSE
Phone: 719-526-7439