Healthcare Provider Details

I. General information

NPI: 1871985887
Provider Name (Legal Business Name): US ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2015
Last Update Date: 02/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR
FT CARSON CO
80913-4613
US

IV. Provider business mailing address

6826 SASSER DR APT A
COLORADO SPRINGS CO
80902-2194
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7732
  • Fax:
Mailing address:
  • Phone: 704-651-8164
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number1125466
License Number StateCO

VIII. Authorized Official

Name: JEANETTE BOUNDS
Title or Position: CREDENTIALS OFFICE
Credential:
Phone: 719-526-7732