NPIMap

Organization Active NPI

Coffee Medical Group LLC

  • General Acute Care Hospital
  • Manchester, TN
National Provider Identifier
1104995281
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
License
0000000017 Issued in TN
Legal business name
COFFEE MEDICAL GROUP LLC
Practice address
1001 McArthur St
Manchester, TN 37355-2419
Phone
(931) 461-3436
Fax
(931) 461-2587
NPI assigned
Nov 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. Robert George
Title
Chief Financial Officer
Phone
(931) 461-3439

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X 0000000017 TN Primary

Addresses

Primary practice location

1001 McArthur St
Manchester, TN 37355-2419

Mailing address

1001 McArthur St
Manchester, TN 37355-2419
Phone (931) 461-3436

Other names 1

  • dba United Regional Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080205000119 TN Part A Provider - Hospital 1850208794 Practice locations: Manchester, TN

Hospital certification: CCN 44U007

Legal name
COFFEE MEDICAL GROUP LLC
Doing business as
UNITY MEDICAL CENTER
Organization structure
LLCNon-profit
Incorporated
Jun 1, 2002 in TN
Enrollment address
481 Interstate Dr
Manchester, TN 37355-3108
Hospital Swing-Bed Unit
Hospital subgroups
Swing-bed approved

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Coffee Medical Group LLC8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 4

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Unity Medical Center Inc Organization, Manchester, TN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jun 1, 2016 100%
Pamela Jernigan Individual Corporate DirectorDirector Aug 1, 2010
W-2 Managing EmployeeW-2 Managing Employee Aug 1, 2010
Martha McCormick Individual Corporate OfficerCeo Mar 11, 2013
W-2 Managing EmployeeCeo Mar 13, 2013
Doug McAbee Individual Corporate OfficerCfo Feb 1, 2024 25%

Facilities with the same owner 3

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104995281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 MCARTHUR ST",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373552419",
            "telephone_number": "931-461-3436",
            "fax_number": "931-461-2587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 MCARTHUR ST",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373552419",
            "telephone_number": "931-461-3436",
            "fax_number": "931-461-2587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COFFEE MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "GEORGE",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "931-461-3439",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": "TN",
            "license": "0000000017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "dba United Regional Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manchester, TN

Sources for this page

Verify at the official NPI Registry.