Provider Demographics
NPI:1073588711
Name:EDWARD W SPARROW HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:EDWARD W SPARROW HOSPITAL ASSOCIATION
Other - Org Name:UNIVERSITY OF MICHIGAN HEALTH-SPARROW LANSING
Other - Org Type:Doing Business As
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:517-364-6000
Mailing Address - Fax:517-364-6009
Practice Address - Street 1:1215 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1811
Practice Address - Country:US
Practice Address - Phone:517-364-6000
Practice Address - Fax:517-364-6009
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARROW HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-02-17
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
276400000X
MI330060282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
No276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000000470OtherPHP FAMILY CARE MASON UC
MI405171969Medicaid
MI301557293Medicaid
MI00025OtherBLUE CROSS
MI200000000005OtherPHP FAMILY CARE SPARROW
MI200000000475OtherPHP FAMILY CARE WT MGMT
MI230230Medicare Oscar/Certification