Organization
US ARMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD BLACK MPA-C (IPAP PHASE 2 DIRECTOR)
(270) 956-0178
Entity
Organization
Contact information
Practice address
650 JOEL DR, C/O DON BLACK, BLUE CLINIC, FORT CAMPBELL, KY 42223-5318
(270) 956-0178
Mailing address
3110 LYLEWOOD RD, WOODLAWN, TN 37191-8232
(931) 542-6193
Taxonomy
Speciality
Code
Description
License number
State
2865X1600X
Operational (Transportable) Military General Acute Care Hospital
Primary
—
—
Other
Enumeration date
10/01/2010
Last updated
10/01/2010
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