Organization
US ARMY HEALTH CLINIC
Active
Parent organization
EVANS ARMY COMMUNITY HOSPITAL
Other names
OHC DUGWAY PROVING GROUND
Organization subpart
Yes
Provider details
NPI number
Legal business name
EVANS ARMY COMMUNITY HOSPITAL
Authorized official
ELIZABETH BURLINGAME (UBO MANAGER)
(719) 526-7291
Entity
Organization
Contact information
Practice address
5116 KISTER AVE, RM #119, DUGWAY, UT 84022-1097
(435) 831-3313
(435) 831-3360
Mailing address
5116 KISTER AVE, ATTN: MSA OFFICE, DUGWAY, UT 84022-1097
(435) 831-3313
(435) 831-3360
Taxonomy
Speciality
Code
Description
License number
State
261QM1100X
Military/U.S. Coast Guard Outpatient Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4609307
NCPDP
—
01
—
AN2598588
MEDCO
—
Enumeration date
05/27/2006
Last updated
11/17/2015
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