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General NPI Number Information
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NPI Number | 1205213014
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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 | 04/30/2015
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 2446 JOLLY RD STE B
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City | OKEMOS
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State | MI
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Zip | 48864-3514
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Country | US
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Telephone | 517-253-5530
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Fax | 517-253-5535
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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 | 517-364-6200
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Fax | 517-364-6208
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Authorized Official
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Title or Position | REGIONAL MGR, 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 | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1060000091
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License Number State | MI
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Taxonomy #2
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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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