Healthcare Provider Details

I. General information

NPI: 1699721357
Provider Name (Legal Business Name): EDWARD W. SPARROW HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 RAMBLEWOOD DR
EAST LANSING MI
48823-6384
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-332-3500
  • Fax: 517-332-3046
Mailing address:
  • Phone: 517-332-3500
  • Fax: 517-332-3046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2471B0102X
TaxonomyBone Densitometry Radiologic Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. DIANE S GALLUPS
Title or Position: DIRECTOR, PROFESSIONAL BILLING
Credential:
Phone: 517-364-6251