1043319858 NPI number — EVANS ARMY COMMUNITY HOSPITAL

Table of content: (NPI 1043319858)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043319858 NPI number — EVANS ARMY COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EVANS ARMY COMMUNITY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043319858
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
EVANS ARMY COMMUNITY HOSPITAL
Provider Second Line Business Mailing Address:
1650 COCHRANE CIR ATTN THIRD PARTY OFFICE
Provider Business Mailing Address City Name:
FT CARSON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80913-4603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-526-5286
Provider Business Mailing Address Fax Number:
719-526-2942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6911 TITUS BLVD BLDG 2353
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FT CARSON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80913-4429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-526-5286
Provider Business Practice Location Address Fax Number:
719-526-2942
Provider Enumeration Date:
09/21/2006

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 332000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2003334 . This is a "PK" identifier . This identifiers is of the category "OTHER".




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