Healthcare Provider Details

I. General information

NPI: 1013079128
Provider Name (Legal Business Name): SPARROW IONIA HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 03/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 E WASHINGTON ST
IONIA MI
48846-2202
US

IV. Provider business mailing address

PO BOX 1001 520 E WASHINGTON ST
IONIA MI
48846-6001
US

V. Phone/Fax

Practice location:
  • Phone: 616-523-1400
  • Fax: 616-523-1429
Mailing address:
  • Phone: 616-523-1400
  • Fax: 616-523-1429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM ROESER
Title or Position: CEO
Credential:
Phone: 616-523-1400