Provider Demographics
NPI:1003097882
Name:SPARROW EATON HOSPITAL
Entity Type:Organization
Organization Name:SPARROW EATON HOSPITAL
Other - Org Name:HAYES GREEN BEACH MEMORIAL HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:SUPERVISOR, PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:GUNTER
Authorized Official - Last Name:RUSSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-253-6308
Mailing Address - Street 1:8175 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0081
Mailing Address - Country:US
Mailing Address - Phone:517-485-0001
Mailing Address - Fax:517-485-1138
Practice Address - Street 1:111 LANSING ST
Practice Address - Street 2:SUITE 230
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-2400
Practice Address - Country:US
Practice Address - Phone:517-543-9563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARROW HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-11-20
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0B31001OtherBCBSM
MI0B31001OtherBCBSM