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Organization
W.A. FOOTE MEMORIAL HOSPITAL, INC
Active
Organization
W.A. FOOTE MEMORIAL HOSPITAL, INC
Active
Parent organization
HENRY FORD ALLEGIANCE HEALTH GROUP
Other names
Henry Ford Allegiance Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
HENRY FORD ALLEGIANCE HEALTH GROUP
Authorized official
MARK SMITH (SVP, CMO, CEO)
(517) 205-6407
Entity
Organization
Contact information
Practice address
205 N. EAST AVE, ATTN: PROVIDER ENROLLMENT, JACKSON, MI 49201
(517) 841-7843
(517) 841-7419
Mailing address
PO BOX 67000, DEPARTMENT 272801, DETROIT, MI 48267
(517) 841-7843
(517) 841-7419
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
1060000044
MI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
—
—
207RH0002X
Hospice and Palliative Medicine (Internal Medicine) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760437826
—
MI
Enumeration date
01/25/2017
Last updated
12/13/2024
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