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
163W00000X
Registered Nurse
—
MI
363L00000X
Nurse Practitioner
Primary
—
—
367A00000X
Advanced Practice Midwife
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500C810310
BCBSM/CNP
MI
01
—
CC5829
RR MEDICARE
MI
Enumeration date
07/11/2006
Last updated
03/06/2024
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