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General NPI Number Information
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NPI Number | 1881800506
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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 | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1650 COCHRANE CIR BUILDING 2059
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City | FT CARSON
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State | CO
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Zip | 80913-4603
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Country | US
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Telephone | 719-526-2939
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Fax | 719-526-7181
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Provider Business Mailing Address
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Address Line | 1650 COCHRANE CIR ATTN CREDENTIALS OFFICE
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City | FT CARSON
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State | CO
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Zip | 80913-4603
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Country | US
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Telephone | 719-526-7844
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Fax | 719-526-7984
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Authorized Official
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Title or Position | CHIEF, PUBLIC HEALTH NURSING
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Name | YOUNG-HEE SONG
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Credential | N.P
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Telephone | 719-526-6414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | 175234
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License Number State | CO
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