Provider Demographics
NPI:1881800506
Name:EVANS ARMY COMMUNITY HOSPITAL
Entity type:Organization
Organization Name:EVANS ARMY COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF, PUBLIC HEALTH NURSING
Authorized Official - Prefix:
Authorized Official - First Name:YOUNG-HEE
Authorized Official - Middle Name:
Authorized Official - Last Name:SONG
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:719-526-6414
Mailing Address - Street 1:1650 COCHRANE CIR
Mailing Address - Street 2:ATTN CREDENTIALS OFFICE
Mailing Address - City:FT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4603
Mailing Address - Country:US
Mailing Address - Phone:719-526-7844
Mailing Address - Fax:719-526-7984
Practice Address - Street 1:1650 COCHRANE CIR
Practice Address - Street 2:BUILDING 2059
Practice Address - City:FT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4603
Practice Address - Country:US
Practice Address - Phone:719-526-2939
Practice Address - Fax:719-526-7181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO175234163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity HealthGroup - Single Specialty