Provider Demographics
NPI:1497795702
Name:EVANS ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:EVANS ARMY COMMUNITY HOSPITAL
Other - Org Name:ATTN: UNIFORM BUSINESS OFFICE
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF, UNIFORM BUSINESS OFFICE
Authorized Official - Prefix:MS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:MARGARITA MARIA
Authorized Official - Last Name:BURLINGAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-526-7291
Mailing Address - Street 1:1650 COCHRANE CIR BLDG 7500
Mailing Address - Street 2:
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4613
Mailing Address - Country:US
Mailing Address - Phone:800-642-6700
Mailing Address - Fax:719-526-7247
Practice Address - Street 1:1650 COCHRANE CIR BLDG 7500
Practice Address - Street 2:ATTN: TREASURER'S OFFICE
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-526-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No341800000XTransportation ServicesMilitary/U.S. Coast Guard Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
0616637OtherMAIN PHARMACY NCPDP
AN2598588OtherMEDCO
0616637OtherMAIN PHARMACY NCPDP
OTH000Medicare UPIN