Basic Information
| Provider Information | |||||||||
| NPI: | 1073588711 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDWARD W SPARROW HOSPITAL ASSOCIATION | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1215 E MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489121811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173646000 | ||||||||
| FaxNumber: | 5173646009 | ||||||||
| Practice Location | |||||||||
| Address1: | 1215 E MICHIGAN AVE | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489121811 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173646000 | ||||||||
| FaxNumber: | 5173646009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/17/2006 | ||||||||
| LastUpdateDate: | 11/09/2016 | ||||||||
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| AuthorizedOfficialLastName: | REICHLE | ||||||||
| AuthorizedOfficialFirstName: | PAULA | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | SVP AND CFO | ||||||||
| AuthorizedOfficialTelephone: | 5173641000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 276400000X | N | Hospital Units | Rehabilitation, Substance Use Disorder Unit | 282N00000X | 330060 | MI | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 00025 | 01 | MI | BLUE CROSS | OTHER | 200000000470 | 01 | MI | PHP FAMILY CARE MASON UC | OTHER | 200000000475 | 01 | MI | PHP FAMILY CARE WT MGMT | OTHER | 405171969 | 05 | MI | MEDICAID | 200000000005 | 01 | MI | PHP FAMILY CARE SPARROW | OTHER | 301557293 | 05 | MI | MEDICAID |