Provider Demographics
NPI:1083669881
Name:EDWARD W. SPARROW HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:EDWARD W. SPARROW HOSPITAL ASSOCIATION
Other - Org Name:RESIDENT OB GYN EDUCATIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT, REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:AMI
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:KIHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-253-6000
Mailing Address - Street 1:PO BOX 13008
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48901-3008
Mailing Address - Country:US
Mailing Address - Phone:517-364-2570
Mailing Address - Fax:517-364-3558
Practice Address - Street 1:1322 E MICHIGAN AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2199
Practice Address - Country:US
Practice Address - Phone:517-364-2570
Practice Address - Fax:517-485-3558
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARD W. SPARROW HOSPITAL ASSOCIATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI160C363170OtherBCBS GROUP NUMBER
MI0C36317Medicare PIN