Provider Demographics
NPI:1366503450
Name:EDWARD W. SPARROW HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:EDWARD W. SPARROW HOSPITAL ASSOCIATION
Other - Org Name:SPARROW PHARMACY PLUS #1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MELARAGNI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:517-364-7455
Mailing Address - Street 1:1100 W SAGINAW ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48915-1925
Mailing Address - Country:US
Mailing Address - Phone:517-364-7455
Mailing Address - Fax:517-364-7465
Practice Address - Street 1:1100 W SAGINAW ST
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1925
Practice Address - Country:US
Practice Address - Phone:517-364-7474
Practice Address - Fax:517-364-7475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5301006692332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4184381Medicaid
MI4184381Medicaid