# WA FOOTE MEMORIAL HOSPITAL, INC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** WA FOOTE MEMORIAL HOSPITAL, INC
- **Other names:** Henry Ford Allegiance Health
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1124052279
- **Legal business name:** WA FOOTE MEMORIAL HOSPITAL, INC
- **Authorized official:** MARK SMITH CFO (SVP, CMO)
- **Authorized official phone:** (517) 205-6407

## Contact information

- **Practice address:** 205 N EAST AVE, JACKSON, MI 49201-1753
- **Practice address phone:** (517) 788-4800
- **Mailing address:** PO BOX 67000, DEPARTMENT 272801, DETROIT, MI 48267-2728
- **Mailing address phone:** (517) 841-7482
- **Mailing address fax:** (517) 841-7476

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 163W00000X | Registered Nurse | — | MI | — |
| 363L00000X | Nurse Practitioner | — | — | Yes |
| 367A00000X | Advanced Practice Midwife | — | — | — |

## Other

- **Enumeration date:** 07/11/2006
- **Last updated:** 03/06/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 500C810310 | BCBSM/CNP | MI |
| 01 | — | CC5829 | RR MEDICARE | MI |