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Organization
WA FOOTE MEMORIAL HOSPITAL, INC
Active
Organization
WA FOOTE MEMORIAL HOSPITAL, INC
Active
Parent organization
WA FOOTE MEMORIAL HOSPITAL, INC
Other names
Henry Ford Allegiance Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
WA FOOTE MEMORIAL HOSPITAL, INC
Authorized official
MARK SMITH MD (SVP - CMO, CEO - HFA)
(517) 205-6407
Entity
Organization
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4800
Mailing address
DEPARTMENT 272801, PO BOX 67000, DETROIT, MI 48267-2728
(517) 841-7482
(517) 841-7476
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
MI
261QP2300X
Primary Care Clinic/Center
—
MI
363A00000X
Physician Assistant
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700C312920
BCBSM #
MI
01
—
CC5829
RR MEDICARE
MI
Enumeration date
05/31/2006
Last updated
03/06/2024
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