Provider Demographics
NPI:1801971643
Name:SPARROW HEALTH SYSTEM
Entity type:Organization
Organization Name:SPARROW HEALTH SYSTEM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:W
Authorized Official - Last Name:KEAVENEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:517-364-3900
Mailing Address - Street 1:1322 E MICHIGAN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-2199
Mailing Address - Country:US
Mailing Address - Phone:514-364-3900
Mailing Address - Fax:517-364-3915
Practice Address - Street 1:1322 E MICHIGAN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2199
Practice Address - Country:US
Practice Address - Phone:514-364-3900
Practice Address - Fax:517-364-3915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060467261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP103289OtherBCN
MIP103289OtherBCN
MIF21810Medicare UPIN