Basic Information
| Provider Information | |||||||||
| NPI: | 1881800506 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EVANS ARMY COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 COCHRANE CIR | ||||||||
| Address2: | ATTN CREDENTIALS OFFICE | ||||||||
| City: | FT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267844 | ||||||||
| FaxNumber: | 7195267984 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 COCHRANE CIR | ||||||||
| Address2: | BUILDING 2059 | ||||||||
| City: | FT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195262939 | ||||||||
| FaxNumber: | 7195267181 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SONG | ||||||||
| AuthorizedOfficialFirstName: | YOUNG-HEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF, PUBLIC HEALTH NURSING | ||||||||
| AuthorizedOfficialTelephone: | 7195266414 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | N.P | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WC1500X | 175234 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Providers | Registered Nurse | Community Health |
No ID Information.