Provider Demographics
NPI:1477512424
Name:EDWARD W. SPARROW HOSPITAL ASSOCIATION
Entity Type:Organization
Organization Name:EDWARD W. SPARROW HOSPITAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:M
Authorized Official - Last Name:REICHLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-364-1000
Mailing Address - Street 1:P.O. BOX 30480
Mailing Address - Street 2:1215 E. MICHIGAN AVENUE
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48909-7980
Mailing Address - Country:US
Mailing Address - Phone:517-364-6000
Mailing Address - Fax:517-364-6009
Practice Address - Street 1:1215 E. MICHIGAN AVENUE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48909-7980
Practice Address - Country:US
Practice Address - Phone:517-364-6000
Practice Address - Fax:517-364-6009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI330060273Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273Y00000XHospital UnitsRehabilitation Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI200000000005OtherPHP
MI00025OtherBLUE CROSS
MI2775312Medicaid
MI23T230Medicare Oscar/Certification