Provider Demographics
NPI:1700820065
Name:SPARROW IONIA HOSPITAL
Entity Type:Organization
Organization Name:SPARROW IONIA HOSPITAL
Other - Org Name:UNIVERSITY OF MICHIGAN HEALTH-SPARROW IONIA
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:616-523-1400
Mailing Address - Fax:616-523-1429
Practice Address - Street 1:3565 S STATE RD
Practice Address - Street 2:
Practice Address - City:IONIA
Practice Address - State:MI
Practice Address - Zip Code:48846-9416
Practice Address - Country:US
Practice Address - Phone:616-523-1400
Practice Address - Fax:616-523-1429
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARROW HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-06-16
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI340021282NC0060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282NC0060XHospitalsGeneral Acute Care HospitalCritical Access
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI60054OtherAETNA
MI1001006OtherMCLAREN HEALTH PLAN
MI301557758Medicaid
MI667OtherPRIORITY HEALTH
MI00142OtherBLUE CROSS BLUE SHIELD
MI405170925Medicaid
MI231331Medicare Oscar/Certification
MI301557758Medicaid