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
JEANNE' WICKENS CFO (SENIOR VICE PRESIDENT OF FINANCE)
(517) 841-6979
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
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
500C810570
BCBSM CNP
MI
01
—
CC5829
RR MEDICARE
MI
Enumeration date
07/07/2006
Last updated
04/01/2016
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