Healthcare Provider Details

I. General information

NPI: 1669686754
Provider Name (Legal Business Name): EVANS ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 04/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45825 E STATE HIGHWAY 96
PUEBLO CO
81006-9330
US

IV. Provider business mailing address

1650 COCHRANE CIR ATTN THIRD PARTY OFFICE
FT CARSON CO
80913-4603
US

V. Phone/Fax

Practice location:
  • Phone: 719-526-7000
  • Fax:
Mailing address:
  • Phone: 719-503-7045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH BURLINGAME
Title or Position: UBO MANAGER
Credential:
Phone: 719-526-7291