Organization
W A FOOTE MEMORIAL HOSPITAL INC
Active
Parent organization
W A FOOTE MEMORIAL HOSPITAL INC
Other names
Henry Ford Allegiance Health Radiation Oncology
Organization subpart
Yes
Provider details
NPI number
Legal business name
W A FOOTE MEMORIAL HOSPITAL INC
Authorized official
MARK SMITH (SVP)
(517) 205-6407
Entity
Organization
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-4800
Mailing address
PO BOX 67000 DEPT 272801 ATTN: PROVIDER ENROLLMENT, DETROIT, MI 48267-0001
(517) 205-4438
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0M957250
MEDICARE
MI
Enumeration date
04/19/2019
Last updated
03/06/2024
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