Provider Demographics
NPI:1841425022
Name:COLDWATER CROSSING INTERNAL MEDICINE, PLLC.
Entity Type:Organization
Organization Name:COLDWATER CROSSING INTERNAL MEDICINE, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:517-278-8000
Mailing Address - Street 1:327 W CHICAGO ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-2805
Mailing Address - Country:US
Mailing Address - Phone:517-278-8000
Mailing Address - Fax:517-278-8007
Practice Address - Street 1:327 W CHICAGO ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2805
Practice Address - Country:US
Practice Address - Phone:517-278-8000
Practice Address - Fax:517-278-8007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-18
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401009358101YP2500X
MI5101011799207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI114836462Medicaid
MI0A26073Medicare PIN