Provider Demographics
NPI:1558541698
Name:COLDWATER SURGERY PC
Entity Type:Organization
Organization Name:COLDWATER SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SENNISH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-279-4720
Mailing Address - Street 1:360 E CHICAGO ST STE 100
Mailing Address - Street 2:PO BOX 629
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2086
Mailing Address - Country:US
Mailing Address - Phone:517-279-4720
Mailing Address - Fax:517-279-4882
Practice Address - Street 1:360 E CHICAGO ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2086
Practice Address - Country:US
Practice Address - Phone:517-279-4720
Practice Address - Fax:517-279-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301043259208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3113803Medicaid