MEDICARE: SPARROW CARSON 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	261QR1300X	Rural Health Clinic/Center

General Provider Information

NPI Number	:	1689644403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPARROW CARSON HOSPITAL

Provider Business Mailing Address
First Line	:	8175 RELIABLE PKWY
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60686-0081
Country	:	US
Telephone Number	:	989-584-3131
Fax Number	:	989-584-6734

Provider Business Practice Location Address
First Line	:	1014 E WASHINGTON ST
Second Line	:
City	:	GREENVILLE
State	:	MI
Zip	:	48838
Country	:	US
Telephone Number	:	616-754-7145
Fax Number	:	616-754-7110

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

Provider Enumeration Date	:	01/24/2006
Last Update Date	:	04/05/2024

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