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General NPI Number Information
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NPI Number | 1023659802
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Entity Type | Organization
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Legal Business Name | EDWARD W SPARROW HOSPITAL ASSOCIATION
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Dates
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Enumeration Date | 10/03/2019
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Last Update Date | 03/27/2024
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Provider Practice Location Address
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Address Line | 1200 E MICHIGAN AVE STE 101
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City | LANSING
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State | MI
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Zip | 48912-1800
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Country | US
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Telephone | 517-364-5552
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Fax | 517-364-5544
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Provider Business Mailing Address
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Address Line | 8175 RELIABLE PKWY
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City | CHICAGO
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State | IL
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Zip | 60686-0081
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Country | US
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Telephone | 517-253-6320
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Fax | 517-253-6321
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Authorized Official
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Title or Position | SUPERVISOR, PROVIDER ENROLLMENT
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Name | MISTY GUNTER RUSSIAN
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Credential |
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Telephone | 517-253-6308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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