Provider Demographics
NPI:1497319487
Name:COFFEY MEDICAL AND URGENT CARE GROUP, PLLC
Entity Type:Organization
Organization Name:COFFEY MEDICAL AND URGENT CARE GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-215-2124
Mailing Address - Street 1:PO BOX 4729
Mailing Address - Street 2:
Mailing Address - City:ONEIDA
Mailing Address - State:TN
Mailing Address - Zip Code:37841-4729
Mailing Address - Country:US
Mailing Address - Phone:423-569-5454
Mailing Address - Fax:423-569-5932
Practice Address - Street 1:281 UNDERPASS DR
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-5885
Practice Address - Country:US
Practice Address - Phone:423-569-5454
Practice Address - Fax:423-569-5932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-25
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty