Healthcare Provider Details

I. General information

NPI: 1881640548
Provider Name (Legal Business Name): EDWARED W. SPARROW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 03/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 E MICHIGAN AVE SUITE 570
LANSING MI
48912-1800
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-5260
  • Fax: 517-364-5296
Mailing address:
  • Phone: 517-364-6253
  • Fax: 517-364-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CHRIS EUGENE BERGMAN
Title or Position: SENIOR VICE PRESIDENT / CFO
Credential:
Phone: 517-364-5400