Healthcare Provider Details

I. General information

NPI: 1154323962
Provider Name (Legal Business Name): COLDWATER MEDICAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 S OAK ST
COLDWATER OH
45828-1622
US

IV. Provider business mailing address

407 S OAK ST
COLDWATER OH
45828-1622
US

V. Phone/Fax

Practice location:
  • Phone: 419-678-2354
  • Fax: 419-678-4716
Mailing address:
  • Phone: 419-678-2354
  • Fax: 419-678-4716

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. JOHN J NAVEAU
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-678-2354