MEDICARE: SPARROW EATON HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	230020	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0B31014	OTHER	MI	BCN ORTHO GROUP NUMBER

General Provider Information

NPI Number	:	1043419427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARROW EATON HOSPITAL

Provider Business Mailing Address
First Line	:	8175 RELIABLE PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0081
Country	:	US
Telephone Number	:	517-253-6320
Fax Number	:	517-253-6321

Provider Business Practice Location Address
First Line	:	616 MEIJER DR
Second Line	:
City	:	CHARLOTTE
State	:	MI
Zip	:	48813-8457
Country	:	US
Telephone Number	:	517-541-7976
Fax Number	:	517-543-8174

Authorized Official
Title or Position	:	SUPERVISOR
Name	:	MISTY GUNTER RUSSIAN
Credential	:
Telephone Number	:	517-253-6308

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	03/26/2024

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Directions to “SPARROW EATON HOSPITAL ” Practice Location

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