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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 CFO (SVP. CMO)
(517) 205-6407
Entity
Organization
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 788-4800
Mailing address
PO BOX 67000, DEPARTMENT 272801, DETROIT, MI 48267-2728
(517) 841-7482
(517) 841-7476
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
MI
207RC0000X
Cardiovascular Disease Physician
—
MI
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
—
MI
207RN0300X
Nephrology Physician
—
MI
207RP1001X
Pulmonary Disease Physician
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
700C860070
BCBSM/MD/DO
MI
01
—
CC5829
RR MEDICARE
MI
Enumeration date
07/10/2006
Last updated
03/06/2024
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