Provider Demographics
NPI:1013969179
Name:COFFEE MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:COFFEE MEDICAL GROUP LLC
Other - Org Name:UNITY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCORMICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-728-6354
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:931-728-6354
Mailing Address - Fax:
Practice Address - Street 1:481 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-3108
Practice Address - Country:US
Practice Address - Phone:931-728-3586
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2022-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000017282NR1301X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NR1301XHospitalsGeneral Acute Care HospitalRural
Provider Identifiers
StateIdentifier IDID TypeIssuer
4039933OtherBCBS
4039933OtherBLUE CARE TENN CARE SEL
TN0440007Medicaid
4039933OtherBCBST
440007Medicare PIN