Healthcare Provider Details

I. General information

NPI: 1588586911
Provider Name (Legal Business Name): EDWARD W SPARROW HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE STE 510
LANSING MI
48912-1800
US

IV. Provider business mailing address

1200 E MICHIGAN AVE STE 510
LANSING MI
48912-1800
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5184
  • Fax: 517-364-5185
Mailing address:
  • Phone: 517-364-5184
  • Fax: 517-364-5185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MISTY GUNTER RUSSIAN
Title or Position: REGIONAL MANAGER, ENROLLMENT
Credential:
Phone: 517-253-6308