Provider Demographics
NPI:1568550655
Name:SPARROW IONIA HOSPITAL
Entity Type:Organization
Organization Name:SPARROW IONIA HOSPITAL
Other - Org Name:PROS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ROESER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-523-1400
Mailing Address - Street 1:PO BOX 1001
Mailing Address - Street 2:520 E WASHINGTON ST
Mailing Address - City:IONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48846-6001
Mailing Address - Country:US
Mailing Address - Phone:616-523-1400
Mailing Address - Fax:616-523-1429
Practice Address - Street 1:429 W LINCOLN AVE
Practice Address - Street 2:SUITE H
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-1144
Practice Address - Country:US
Practice Address - Phone:616-527-0558
Practice Address - Fax:616-523-1429
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARROW IONIA HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-11
Last Update Date:2014-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI231331Medicare PIN