# COFFEE MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CENTER FOR FAMILY MEDICINE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700192028
- **Authorized official:** MR. ROBERT J COUCH (CEO)
- **Authorized official phone:** (931) 728-6354

## Contact information

- **Practice address:** 1615 MCMINNVILLE HWY, MANCHESTER, TN 37355-3179
- **Practice address phone:** (931) 728-6205
- **Practice address fax:** (931) 723-3194
- **Mailing address:** 1615 MCMINNVILLE HWY, MANCHESTER, TN 37355-3179
- **Mailing address phone:** (931) 728-6205
- **Mailing address fax:** (931) 723-3194

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 19 | TN | Yes |

## Other

- **Enumeration date:** 08/24/2010
- **Last updated:** 02/09/2024