Provider Demographics
NPI:1710566450
Name:COFFEE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:COFFEE MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DOUG
Authorized Official - Middle Name:
Authorized Official - Last Name:MCABEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-450-1109
Mailing Address - Street 1:481 INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-3108
Mailing Address - Country:US
Mailing Address - Phone:931-450-1109
Mailing Address - Fax:931-450-1976
Practice Address - Street 1:1034 MCARTHUR ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2454
Practice Address - Country:US
Practice Address - Phone:931-450-1120
Practice Address - Fax:931-450-1976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health