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General NPI Number Information
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NPI Number | 1013969179
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Entity Type | Organization
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Legal Business Name | COFFEE MEDICAL GROUP LLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 04/13/2022
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Provider Practice Location Address
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Address Line | 481 INTERSTATE DR
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City | MANCHESTER
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State | TN
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Zip | 37355-3108
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Country | US
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Telephone | 931-728-3586
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Fax |
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Provider Business Mailing Address
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Address Line | 481 INTERSTATE DR
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City | MANCHESTER
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State | TN
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Zip | 37355-3108
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Country | US
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Telephone | 931-728-6354
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. MARTHA E MCCORMICK
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Credential |
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Telephone | 931-728-6354
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NR1301X
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Taxonomy Name | Rural Acute Care Hospital
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License Number | 0000000017
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License Number State | TN
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