Organization
WA FOOTE MEMORIAL HOSPITAL, INC
Active
Parent organization
WA FOOTE MEMORIAL HOSPITAL, INC
Other names
Allegiance Health
Organization subpart
Yes
Provider details
NPI number
Legal business name
WA FOOTE MEMORIAL HOSPITAL, INC
Authorized official
MARK SMITH CFO (SVP - CMO, CEO HFAMG EXECUTIVE)
(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) 841-6913
(517) 841-6917
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
—
MI
104100000X
Social Worker
—
MI
2084P0800X
Psychiatry Physician
Primary
—
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
260C863890
BCBSM
MI
01
—
680C810300
BCBSM
MI
01
—
750910501/800C810270
BCBSM LMSW/LLMSW
MI
01
—
CC5829
RR MEDICARE
MI
Enumeration date
07/10/2006
Last updated
03/05/2024
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