Basic Information
| Provider Information | |||||||||
| NPI: | 1801563796 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | EDWARD W. SPARROW HOSPITAL ASSOCIATION | ||||||||
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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: | 1200 E MICHIGAN AVE STE 655 | ||||||||
| Address2: | |||||||||
| City: | LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 489121837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5173645388 | ||||||||
| FaxNumber: | 5173645943 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/27/2021 | ||||||||
| LastUpdateDate: | 08/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | KIHN | ||||||||
| AuthorizedOfficialFirstName: | AMI | ||||||||
| AuthorizedOfficialMiddleName: | SUE | ||||||||
| AuthorizedOfficialTitleorPosition: | VP, REVENUE CYCLE MANAGEMENT | ||||||||
| AuthorizedOfficialTelephone: | 5172536000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2082S0099X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | 2082S0105X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery | Surgery of the Hand | 208200000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.