Provider Demographics
NPI:1790850162
Name:EDWARD W. SPARROW HOSPITAL
Entity Type:Organization
Organization Name:EDWARD W. SPARROW HOSPITAL
Other - Org Name:SPARROW HEALTH SYSTEM MICU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT / CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:BERGMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-364-5400
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:517-364-7282
Mailing Address - Fax:517-364-7280
Practice Address - Street 1:1210 W SAGINAW ST
Practice Address - Street 2:3 RD FLOOR
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48915-1927
Practice Address - Country:US
Practice Address - Phone:517-364-7282
Practice Address - Fax:517-364-7280
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EDWARD W. SPARROW HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-21
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI59-0-C3-0008-0OtherBCBS GROUP NUMBER
MI0M53490Medicare PIN