1235730664 NPI number — EDWARD W. SPARROW HOSPITAL ASSOCIATION

Table of content: MELISSA TOOMAN HERRON PT (NPI 1003906769)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235730664 NPI number — EDWARD W. SPARROW HOSPITAL ASSOCIATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD W. SPARROW HOSPITAL ASSOCIATION
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:
Provider Other Organization Name Type Code:
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:
1235730664
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13008
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:
48901-3008
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-253-6320
Provider Business Mailing Address Fax Number:
517-253-6321

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2900 HANNAH BLVD STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EAST LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48823-5382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-364-8150
Provider Business Practice Location Address Fax Number:
517-364-8151
Provider Enumeration Date:
11/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
KIHN
Authorized Official First Name:
AMI
Authorized Official Middle Name:
Authorized Official Title or Position:
VP, REVENUE CYCLE
Authorized Official Telephone Number:
517-253-6000

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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