Provider Demographics
NPI:1750380978
Name:COUNTY OF COFFEE OFFICE OF COUNTY EXECUTIVE
Entity type:Organization
Organization Name:COUNTY OF COFFEE OFFICE OF COUNTY EXECUTIVE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ACCOUNTS & BUDGETS
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:EDINGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-723-5102
Mailing Address - Street 1:PO BOX 479
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-0479
Mailing Address - Country:US
Mailing Address - Phone:931-723-5102
Mailing Address - Fax:931-723-8225
Practice Address - Street 1:1100 MADISON STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2224
Practice Address - Country:US
Practice Address - Phone:931-723-5137
Practice Address - Fax:931-723-5137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNEMS00000016013416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3524446Medicaid
TN3524446Medicare UPIN
TN3524446Medicaid