Healthcare Provider Details

I. General information

NPI: 1730159062
Provider Name (Legal Business Name): USA MEDDAC FT CARSON, CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FT CARSON CO
80913-4603
US

IV. Provider business mailing address

USA MEDDAC 1650 COCHRANE CIRCLE
FT. CARSON CO
80913
US

V. Phone/Fax

Practice location:
  • Phone: 719-260-7024
  • Fax: 719-524-4893
Mailing address:
  • Phone: 719-526-7024
  • Fax: 716-524-4893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number116725
License Number StateCO

VIII. Authorized Official

Name: MS. ELBA M D'ASARO
Title or Position: CHIEF OF EDUCATION AND TRAINING
Credential: RN
Phone: 719-526-7024