# COFFEE MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MANCHESTER RURAL HEALTH CLINIC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043537046
- **Authorized official:** ROBERT J COUCH (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (931) 728-6354

## Contact information

- **Practice address:** 482 INTERSTATE DR, SUITE A, MANCHESTER, TN 37355-3109
- **Practice address phone:** (931) 728-4718
- **Practice address fax:** (931) 728-1016
- **Mailing address:** 482 INTERSTATE DR, MANCHESTER, TN 37355-3109
- **Mailing address phone:** (931) 728-4718
- **Mailing address fax:** (931) 728-1016

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/29/2010
- **Last updated:** 02/09/2024