Organization
W. A. FOOTE MEMORIAL HOSPITAL, INC
Active
Parent organization
HENRY FORD ALLEGIANCE HEALTH GROUP
Organization subpart
Yes
Provider details
NPI number
Legal business name
HENRY FORD ALLEGIANCE HEALTH GROUP
Authorized official
MARK SMITH (SVP)
(517) 205-6407
Entity
Organization
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-7843
(517) 205-7419
Mailing address
PO BOX 64000 DEPT 64787, DETROIT, MI 48264-0001
(517) 205-7843
(517) 205-7419
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
106000004
MI
2085R0204X
Vascular & Interventional Radiology Physician
Primary
106000004
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106000004
STATE LICENSE NUMBER
MI
Enumeration date
06/27/2017
Last updated
03/06/2024
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