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General NPI Number Information
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NPI Number | 1215941646
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Entity Type | Organization
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Legal Business Name | COFFEE COUNTY HOSPITAL GROUP, INC
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 06/02/2016
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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 | 931-728-6354
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Fax | 931-728-5420
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Provider Business Mailing Address
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Address Line | PO BOX 1409
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City | MANCHESTER
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State | TN
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Zip | 37349-4409
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Country | US
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Telephone | 931-728-6354
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Fax | 931-728-5420
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ROBERT J. COUCH
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Credential | CEO
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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 | 282NC0060X
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Taxonomy Name | Critical Access Hospital
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License Number | 000000000019
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License Number State | TN
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