Provider Demographics
NPI:1649248014
Name:DEPARTMENT OF THE ARMY USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:DEPARTMENT OF THE ARMY USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:R.N. OB/GYN CLINIC TRAIGE DEPARTMEN
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:BALL
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:719-526-7439
Mailing Address - Street 1:USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:1650 COCHRANE CIRCLE OB/GYN CLINIC
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80911
Mailing Address - Country:US
Mailing Address - Phone:719-526-7439
Mailing Address - Fax:719-526-7850
Practice Address - Street 1:USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:OB/GYN CLINIC 1650 COCHRANE CIR
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80911
Practice Address - Country:US
Practice Address - Phone:719-526-7439
Practice Address - Fax:719-526-7850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO150011261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty