MEDICARE: EVANS ARMY COMMUNITY HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2003338	OTHER		PK

General Provider Information

NPI Number	:	1518066273
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANS ARMY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	EVANS ARMY COMMUNITY HOSPITAL
Second Line	:	1650 COCHRANE CIR ATTN THIRD PARTY OFFICE
City	:	FT CARSON
State	:	CO
Zip	:	80913-4603
Country	:	US
Telephone Number	:	210-221-8274
Fax Number	:

Provider Business Practice Location Address
First Line	:	6351 WETZEL AVE
Second Line	:	BLDG 1525
City	:	FT CARSON
State	:	CO
Zip	:	80913-4188
Country	:	US
Telephone Number	:	719-524-1060
Fax Number	:	719-526-7749

Authorized Official
Title or Position	:	DEPUTY DIRECTOR PHCY OPS CTR
Name	:	HECTOR MORALES
Credential	:
Telephone Number	:	210-221-8443

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	01/20/2015

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Directions to “EVANS ARMY COMMUNITY HOSPITAL ” Practice Location

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