1881640548 NPI number — EDWARED W. SPARROW HOSPITAL

Table of content: (NPI 1881640548)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881640548 NPI number — EDWARED W. SPARROW HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARED W. SPARROW HOSPITAL
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:
PHYSICIAL MEDICINE & REHABILITATION
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:
1881640548
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2008
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:
517-364-6253
Provider Business Mailing Address Fax Number:
517-364-6204

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 E MICHIGAN AVE
Provider Second Line Business Practice Location Address:
SUITE 570
Provider Business Practice Location Address City Name:
LANSING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48912-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-364-5260
Provider Business Practice Location Address Fax Number:
517-364-5296
Provider Enumeration Date:
05/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERGMAN
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
SENIOR VICE PRESIDENT / CFO
Authorized Official Telephone Number:
517-364-5400

Provider Taxonomy Codes

  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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