Provider Demographics
NPI:1841504214
Name:COFFEE REGIONAL MEDICAL CENTER
Entity type:Organization
Organization Name:COFFEE REGIONAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:912-384-1900
Mailing Address - Street 1:PO BOX 1287
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS
Mailing Address - State:GA
Mailing Address - Zip Code:31534-1287
Mailing Address - Country:US
Mailing Address - Phone:912-384-1900
Mailing Address - Fax:912-389-2112
Practice Address - Street 1:523 BOWENS MILL RD SW
Practice Address - Street 2:
Practice Address - City:DOUGLAS
Practice Address - State:GA
Practice Address - Zip Code:31533-3930
Practice Address - Country:US
Practice Address - Phone:912-384-1900
Practice Address - Fax:912-389-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0003443341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000448BMedicaid