Provider Demographics
NPI:1609959691
Name:EDWARD W. SPARROW HOSPITAL ASSOCIATION
Entity type:Organization
Organization Name:EDWARD W. SPARROW HOSPITAL ASSOCIATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-253-6313
Mailing Address - Street 1:3301 E MICHIGAN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48912-4641
Mailing Address - Country:US
Mailing Address - Phone:517-253-6310
Mailing Address - Fax:517-253-6315
Practice Address - Street 1:1200 E MICHIGAN AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-1800
Practice Address - Country:US
Practice Address - Phone:517-364-5380
Practice Address - Fax:517-364-5387
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPARROW HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-23
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X
MI53010067233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2121632OtherPK
MI5171969Medicaid
MI4948665Medicaid
2121632OtherPK