Provider Demographics
NPI:1184792053
Name:SPARROW CARSON HOSPITAL
Entity type:Organization
Organization Name:SPARROW CARSON HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-584-3971
Mailing Address - Street 1:406 E ELM ST
Mailing Address - Street 2:PO BOX 730
Mailing Address - City:CARSON CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48811-9693
Mailing Address - Country:US
Mailing Address - Phone:989-584-3971
Mailing Address - Fax:989-584-6734
Practice Address - Street 1:102 S. THIRD ST.
Practice Address - Street 2:SUITE 500
Practice Address - City:CARSON CITY
Practice Address - State:MI
Practice Address - Zip Code:48811
Practice Address - Country:US
Practice Address - Phone:989-584-6472
Practice Address - Fax:989-584-3747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIOE96012016Medicare PIN
MIOE96012009Medicare PIN
MIOE96012006Medicare PIN
MIOE96012012Medicare PIN
MIOE96012013Medicare PIN
MIOP12380Medicare PIN
MIOE96012018Medicare PIN
MIOE96012019Medicare PIN
MIOE96012017Medicare PIN
MI0E96012Medicare Oscar/Certification
MIOE96012020Medicare PIN