Provider Demographics
NPI:1669686754
Name:EVANS ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:EVANS ARMY COMMUNITY HOSPITAL
Other - Org Name:PUEBLO CIV EMP HLTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLINGAME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-526-7291
Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:ATTN THIRD PARTY OFFICE
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4603
Mailing Address - Country:US
Mailing Address - Phone:719-503-7045
Mailing Address - Fax:
Practice Address - Street 1:45825 E STATE HIGHWAY 96
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81006-9330
Practice Address - Country:US
Practice Address - Phone:719-526-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVANS ARMY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
1497795702OtherPARENT FACILITY NPI 2
OTH000Medicare UPIN
VAD000Medicare UPIN