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General NPI Number Information
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NPI Number | 1205145695
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Entity Type | Organization
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Legal Business Name | US ARMY
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Dates
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Enumeration Date | 10/01/2010
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 650 JOEL DR C/O DON BLACK, BLUE CLINIC
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 270-956-0178
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Fax |
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Provider Business Mailing Address
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Address Line | 3110 LYLEWOOD RD
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City | WOODLAWN
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State | TN
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Zip | 37191-8232
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Country | US
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Telephone | 931-542-6193
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Fax |
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Authorized Official
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Title or Position | IPAP PHASE 2 DIRECTOR
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Name | MR. DONALD BLACK
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Credential | MPA-C
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Telephone | 270-956-0178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865X1600X
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Taxonomy Name | Operational (Transportable) Military General Acute Care Hospital
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License Number |
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License Number State |
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