Provider Demographics
NPI:1114209400
Name:COFFEE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:COFFEE MEDICAL GROUP LLC
Other - Org Name:UNITED REGIONAL MULTI-SPECIALTY GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:A
Authorized Official - Last Name:JERNIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-461-3415
Mailing Address - Street 1:1001 MCARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-2419
Mailing Address - Country:US
Mailing Address - Phone:931-728-3586
Mailing Address - Fax:931-461-2587
Practice Address - Street 1:1001 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2419
Practice Address - Country:US
Practice Address - Phone:931-728-3586
Practice Address - Fax:931-461-2587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty