Organization
W A FOOTE MEMORIAL HOSPITAL INC
Active
Other names
HFAH Free Standing Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
KEVIN LEONARD (VP FINANCE)
(517) 205-7410
Entity
Organization
Contact information
Practice address
205 N EAST AVE, JACKSON, MI 49201-1753
(517) 205-4922
(517) 205-6499
Mailing address
PO BOX 67000 DEPT 272801, DETROIT, MI 48267-2728
(517) 205-7843
(517) 205-7419
Taxonomy
Speciality
Code
Description
License number
State
163WI0500X
Infusion Therapy Registered Nurse
Primary
106000004
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053403402
—
MI
Enumeration date
12/06/2017
Last updated
04/23/2018
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