Healthcare Provider Details

I. General information

NPI: 1598830887
Provider Name (Legal Business Name): EDWARD W. SPARROW HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 W SAGINAW ST 2ND FLOOR
LANSING MI
48915-1927
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-7700
  • Fax: 517-364-7701
Mailing address:
  • Phone: 517-364-7700
  • Fax: 517-364-7701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

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