Provider Demographics
NPI:1013146992
Name:COLEMAN FAMILY CARE, INC
Entity Type:Organization
Organization Name:COLEMAN FAMILY CARE, INC
Other - Org Name:COLEMAN FAMILY CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUELDA
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-582-8820
Mailing Address - Street 1:9437 HIGHWAY 70 EAST
Mailing Address - Street 2:
Mailing Address - City:MC EWEN
Mailing Address - State:TN
Mailing Address - Zip Code:37101-4859
Mailing Address - Country:US
Mailing Address - Phone:931-582-8820
Mailing Address - Fax:931-582-8970
Practice Address - Street 1:9437 HIGHWAY 70 EAST
Practice Address - Street 2:
Practice Address - City:MCEWEN
Practice Address - State:TN
Practice Address - Zip Code:37101-4859
Practice Address - Country:US
Practice Address - Phone:931-582-8820
Practice Address - Fax:931-582-8970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14154261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515234Medicaid
MC1965156OtherDEA NUMBER