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
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1447334677
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	:	550 E WASHINGTON ST
Second Line	:
City	:	IONIA
State	:	MI
Zip	:	48846-2202
Country	:	US
Telephone Number	:	616-523-1600
Fax Number	:	616-523-1601

Authorized Official
Title or Position	:	SUPERVISOR, PROVIDER ENROLLMENT
Name	:	MISTY GUNTER RUSSIAN
Credential	:
Telephone Number	:	517-253-6308

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	03/11/2024

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Practice Location Address:

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48846-2202

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Directions to “SPARROW IONIA HOSPITAL ” Practice Location

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