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NPI Code Detail

MEDICARE: SPARROW CARSON HOSPITAL

MEDICARE: SPARROW CARSON 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
1208VP0014XInterventional Pain Medicine Physician
2367500000XCertified Registered Nurse Anesthetist
3207L00000XAnesthesiology Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1430E910280OTHERMIBCBS CRNAS
2368419900OTHERMIUSDOL
3050E910250OTHERMIBCBS ANESTHESIOLOGISTS

General Provider Information

NPI Number : 1396789798
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPARROW CARSON HOSPITAL
Provider Business Mailing Address
First Line : 8175 RELIABLE PKWY
Second Line :
City : CHICAGO
State : IL
Zip : 60686-0081
Country : US
Telephone Number : 989-584-3971
Fax Number :
Provider Business Practice Location Address
First Line : 406 E ELM ST
Second Line :
City : CARSON CITY
State : MI
Zip : 48811-9693
Country : US
Telephone Number : 989-584-3971
Fax Number :
Authorized Official
Title or Position : SUPERVISOR, PROVIDER ENROLLMENT
Name : MISTY GUNTER RUSSIAN
Credential :
Telephone Number : 517-253-6308
Provider Enumeration Date : 06/15/2006
Last Update Date : 04/05/2024

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Directions to “SPARROW CARSON HOSPITAL ” Practice Location

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