Provider Demographics
NPI:1841568169
Name:EVANS ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:EVANS ARMY COMMUNITY HOSPITAL
Other - Org Name:N/A
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIMARY CARE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:DEIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-526-9277
Mailing Address - Street 1:2400 CODY DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80911-1018
Mailing Address - Country:US
Mailing Address - Phone:719-392-0737
Mailing Address - Fax:
Practice Address - Street 1:2400 CODY DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80911-1018
Practice Address - Country:US
Practice Address - Phone:719-392-0737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TERRI WISNIEWSKI
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-12-01
Last Update Date:2011-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO286500000X286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital