1689654279 NPI number — DR. ATHENA JOYCE STOYAS M.D.

Table of content: DR. ATHENA JOYCE STOYAS M.D. (NPI 1689654279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689654279 NPI number — DR. ATHENA JOYCE STOYAS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STOYAS
Provider First Name:
ATHENA
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1689654279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/17/2021
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 COMMUNITY HOSPITAL
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:
719-526-7653
Provider Business Mailing Address Fax Number:
719-526-7673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USA MEDDACE, EVANS ARMY COMMUNITY HOSPITAL
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PEDIATRICS
Provider Business Practice Location Address City Name:
FORT CARSON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80913-4604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-524-4335
Provider Business Practice Location Address Fax Number:
719-524-4212
Provider Enumeration Date:
01/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  43836 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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