Basic Information
| Provider Information | |||||||||
| NPI: | 1649248014 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEPARTMENT OF THE ARMY USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | 1650 COCHRANE CIRCLE OB/GYN CLINIC | ||||||||
| City: | FT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267439 | ||||||||
| FaxNumber: | 7195267850 | ||||||||
| Practice Location | |||||||||
| Address1: | USA MEDDAC/EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| Address2: | OB/GYN CLINIC 1650 COCHRANE CIR | ||||||||
| City: | FT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267439 | ||||||||
| FaxNumber: | 7195267850 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BALL | ||||||||
| AuthorizedOfficialFirstName: | TERRY | ||||||||
| AuthorizedOfficialMiddleName: | LYNN | ||||||||
| AuthorizedOfficialTitleorPosition: | R.N. OB/GYN CLINIC TRAIGE DEPARTMEN | ||||||||
| AuthorizedOfficialTelephone: | 7195267439 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | REGISTERED NURSE | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 150011 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.