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General NPI Number Information
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NPI Number | 1811943582
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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 | 05/25/2006
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 1200 E MICHIGAN AVE STE 345
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City | LANSING
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State | MI
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Zip | 48912-1894
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Country | US
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Telephone | 517-364-5610
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Fax | 517-364-5614
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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 | 60686-3008
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Country | US
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Telephone | 517-364-6253
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Fax | 517-364-6204
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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 | 207Q00000X
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Taxonomy Name | Family Medicine 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 | 208600000X
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Taxonomy Name | Surgery 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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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