1992775019 NPI number — USA MEDDAC

Table of content: ALMA YAZMIN GONZALEZ COMMUNITY HEALTH WOR (NPI 1710851654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992775019 NPI number — USA MEDDAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
USA MEDDAC
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:
1992775019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USA MEDDAC EVANS ARMY HOPSITAL
Provider Second Line Business Mailing Address:
1650 COCHRANE CIRCLE; ATTN: CREDENTIALS OFFICE
Provider Business Mailing Address City Name:
FORT CARSON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80913-4604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-526-7844
Provider Business Mailing Address Fax Number:
719-526-7984

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 COCHRANE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT CARSON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80913-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-526-7844
Provider Business Practice Location Address Fax Number:
719-526-7984
Provider Enumeration Date:
01/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
O'RILEY
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
719-526-7155

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  1231 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com