Healthcare Provider Details

I. General information

NPI: 1518066273
Provider Name (Legal Business Name): EVANS ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6351 WETZEL AVE BLDG 1525
FT CARSON CO
80913-4188
US

IV. Provider business mailing address

EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRANE CIR ATTN THIRD PARTY OFFICE
FT CARSON CO
80913-4603
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-1060
  • Fax: 719-526-7749
Mailing address:
  • Phone: 210-221-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: DEPUTY DIRECTOR PHCY OPS CTR
Credential:
Phone: 210-221-8443