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1073588711

NPI Code Detail

MEDICARE: EDWARD W SPARROW HOSPITAL ASSOCIATION

MEDICARE: EDWARD W SPARROW HOSPITAL ASSOCIATION

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	276400000X	Substance Use Disorder Rehabilitation Hospital Unit
2	282N00000X	General Acute Care Hospital	330060	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200000000005	OTHER	MI	PHP FAMILY CARE SPARROW
2	200000000475	OTHER	MI	PHP FAMILY CARE WT MGMT
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	00025	OTHER	MI	BLUE CROSS
5	200000000470	OTHER	MI	PHP FAMILY CARE MASON UC
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073588711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EDWARD W SPARROW HOSPITAL ASSOCIATION

Provider Business Mailing Address
First Line	:	8175 RELIABLE PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0081
Country	:	US
Telephone Number	:	517-364-6000
Fax Number	:	517-364-6009

Provider Business Practice Location Address
First Line	:	1215 E MICHIGAN AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48912-1811
Country	:	US
Telephone Number	:	517-364-6000
Fax Number	:	517-364-6009

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	10/23/2024

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1669431292 — EDWARD W. SPARROW HOSPITAL ASSOCIATION
Practice Location Address:

1215 E MICHIGAN AVE
LANSING, MI
48912-1811

Practice Phone: 517-364-7700
Practice Fax:

Directions to “EDWARD W SPARROW HOSPITAL ASSOCIATION ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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