NPIMap

Organization Active NPI

Coffee Medical Group LLC

  • Skilled Nursing Facility
  • Manchester, TN
National Provider Identifier
1063509271
Registry record updated Jun 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
445383 Issued in TN
Legal business name
COFFEE MEDICAL GROUP LLC
Practice address
1001 McArthur Drive
Manchester, TN 37355
Phone
(931) 728-3586
Fax
(931) 723-0781
NPI assigned
Oct 7, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Holly B Hopkins
Title
Business Office Manager
Phone
(931) 461-3425

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 7440354 TN
Skilled Nursing Facility 314000000X 445383 TN Primary

Addresses

Primary practice location

1001 McArthur Drive
Manchester, TN 37355

Mailing address

1001 McArthur Drive
Manchester, TN 37355
Phone (931) 728-3586

Other identifiers 3

IdentifierTypeStateIssuer
4039933OtherTNBCBS
0445383MedicaidTN
7440354MedicaidTN

Other names 1

  • United Regional Medical Center Nursing Home Doing business as

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

1001 McArthur St
Manchester, TN 37355
Phone (931) 728-3586

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160179200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213920000000",
    "number": "1063509271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 MCARTHUR DRIVE",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "37355",
            "telephone_number": "931-728-3586",
            "fax_number": "931-723-0781"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MCARTHUR DRIVE",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "37355",
            "telephone_number": "931-728-3586",
            "fax_number": "931-723-0781"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-07",
        "last_updated": "2008-06-20",
        "status": "A",
        "authorized_official_last_name": "HOPKINS",
        "authorized_official_first_name": "HOLLY",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "931-461-3425"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "TN",
            "license": "7440354",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "TN",
            "license": "445383",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4039933",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0445383",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7440354",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "United Regional Medical Center Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manchester, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.