Healthcare Provider Details

I. General information

NPI: 1467653170
Provider Name (Legal Business Name): EDWARD W. SPARROW HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 03/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1811
US

IV. Provider business mailing address

PO BOX 13008
LANSING MI
48901-3008
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-6251
  • Fax: 517-364-6208
Mailing address:
  • Phone: 517-364-6253
  • Fax: 517-364-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) 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