Basic Information
| Provider Information | |||||||||
| NPI: | 1164092557 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDWARD W SPARROW HOSPITAL ASSOCIATION | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SMG OWOSSO INTERNAL MEDICINE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13008 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489013008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172536320 | ||||||||
| FaxNumber: | 5172536321 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 HEALTH PARK DR STE 301 | ||||||||
| Address2: | |||||||||
| City: | OWOSSO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488671293 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897238463 | ||||||||
| FaxNumber: | 9897238258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2021 | ||||||||
| LastUpdateDate: | 02/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | KIHN | ||||||||
| AuthorizedOfficialFirstName: | AMI | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | VP REVENUE CYCLE | ||||||||
| AuthorizedOfficialTelephone: | 5172536000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.