Basic Information
| Provider Information | |||||||||
| NPI: | 1376288167 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPARROW IONIA HOSPITAL | ||||||||
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| OtherOrganizationName: | SPARROW MEDICAL GROUP ORTHOPEDICS & SPORTS MEDICINE - IONIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 13008 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489013008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172536308 | ||||||||
| FaxNumber: | 5172536393 | ||||||||
| Practice Location | |||||||||
| Address1: | 3565 S STATE RD | ||||||||
| Address2: | |||||||||
| City: | IONIA | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488469416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172535100 | ||||||||
| FaxNumber: | 5172535110 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/05/2022 | ||||||||
| LastUpdateDate: | 05/05/2022 | ||||||||
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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: | 05/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RS0010X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Sports Medicine | 207X00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XX0005X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine |
No ID Information.