Basic Information
| Provider Information | |||||||||
| NPI: | 1295801108 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPARROW IONIA HOSPITAL | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SMG PORTLAND | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 520 E WASHINGTON ST | ||||||||
| Address2: | P O BOX 1001 | ||||||||
| City: | IONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488461870 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6165231400 | ||||||||
| FaxNumber: | 6165231429 | ||||||||
| Practice Location | |||||||||
| Address1: | 9751 E GRAND RIVER AVE | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488759774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5176476722 | ||||||||
| FaxNumber: | 5176476838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 05/06/2015 | ||||||||
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| AuthorizedOfficialLastName: | ROESER | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6165231400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | SPARROW IONIA HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 261QR1300X | 238631 | MI | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.