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General NPI Number Information
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NPI Number | 1841568169
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Entity Type | Organization
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Legal Business Name | EVANS ARMY COMMUNITY HOSPITAL
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 2400 CODY DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-1018
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Country | US
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Telephone | 719-392-0737
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 CODY DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80911-1018
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Country | US
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Telephone | 719-392-0737
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Fax |
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Authorized Official
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Title or Position | PRIMARY CARE MANAGER
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Name | DR. MARY DEIGHTON
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Credential | DO
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Telephone | 719-526-9277
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 286500000X
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License Number State | CO
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