1942326848 NPI number — SPARROW COMMUNITY CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942326848 NPI number — SPARROW COMMUNITY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPARROW COMMUNITY CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPARROW MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942326848
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
915 E MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANSING
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48912-1417
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-364-2110
Provider Business Mailing Address Fax Number:
517-364-1227

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
922 S MISSION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT PLEASANT
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48858-3548
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
989-772-7244
Provider Business Practice Location Address Fax Number:
989-772-8920
Provider Enumeration Date:
03/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BREWSTER
Authorized Official First Name:
DARWIN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
517-364-2110

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  383243561 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BP3500X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 383243561 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 383243561 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 540C702820 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 874323242 . This is a "MT PLEASANT" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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