| Organization Name: | COFFEE MEDICAL GROUP LLC |
| NPI Number: | 1013969179 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARTHA E MCCORMICK (CEO) |
| Mailing Address: | 481 Interstate Dr Manchester |
| State: | TN US |
| Postal Code: | 373553108 |
| Phone Number: | 9317283586 |
| Fax Number: | |
| NPI Enumeration Date: | 05/17/2006 |
| NPI Last Update Date: | 06/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 282NR1301X |
| License Number: | 0000000017 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TN |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | General Acute Care Hospital |
| Taxonomy Specialization: | Rural |
| Taxonomy Definition: | |