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NPI Code Detail

MEDICARE: SPARROW IONIA HOSPITAL

MEDICARE: SPARROW IONIA HOSPITAL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician
2261QR1300XRural Health Clinic/Center238631MI

General Provider Information

NPI Number : 1295801108
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPARROW IONIA HOSPITAL
Provider Business Mailing Address
First Line : 8175 RELIABLE PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60686-0081
Country : US
Telephone Number : 616-523-1400
Fax Number : 616-523-1429
Provider Business Practice Location Address
First Line : 9751 E GRAND RIVER AVE
Second Line :
City : PORTLAND
State : MI
Zip : 48875-9774
Country : US
Telephone Number : 517-647-6722
Fax Number : 517-647-6838
Authorized Official
Title or Position : SUPERVISOR. PROVIDER ENROLLMENT
Name : MISTY GUNTER RUSSIAN
Credential :
Telephone Number : 517-253-6308
Provider Enumeration Date : 11/24/2006
Last Update Date : 03/11/2024

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Directions to “SPARROW IONIA HOSPITAL ” Practice Location

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