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1326078866

NPI Code Detail

MEDICARE: W.A. FOOTE MEMORIAL HOSPITAL

MEDICARE: W.A. FOOTE MEMORIAL HOSPITAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician
2	104100000X	Social Worker
3	101YP2500X	Professional Counselor		MI
4	103T00000X	Psychologist
5	2084N0400X	Neurology Physician
6	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	CC5829	OTHER	MI	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260C863890	OTHER		BCBSM
2	750910501	OTHER	MI	BCBSM
3	680C810300	OTHER	MI	BCBSM
5	800C810270	OTHER	MI	BCBSM

General Provider Information

NPI Number	:	1326078866
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	W.A. FOOTE MEMORIAL HOSPITAL

Provider Business Mailing Address
First Line	:	PO BOX 670884
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48267-2728
Country	:	US
Telephone Number	:	800-999-5829
Fax Number	:	313-876-1305

Provider Business Practice Location Address
First Line	:	205 N EAST AVE
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49201-1753
Country	:	US
Telephone Number	:	517-788-4800
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	KIMBERLY CEBALT
Credential	:
Telephone Number	:	313-874-6764

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	03/30/2026

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Practice Location Address:

205 N EAST AVE
JACKSON, MI
49201-1753

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1881534691 — SHAWN K KAURA DO
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JACKSON, MI
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1538009246 — ALEJANDRA N/A PEREZ DO
Practice Location Address:

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JACKSON, MI
49201-1753

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Practice Fax:

1396685962 — DR. ROMAN BELTRAN DO
Practice Location Address:

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Directions to “W.A. FOOTE MEMORIAL HOSPITAL ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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