Healthcare Provider Details

I. General information

NPI: 1265806343
Provider Name (Legal Business Name): WA FOOTE MEMORIAL HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2015
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 W FRANKLIN ST
JACKSON MI
49201-2048
US

IV. Provider business mailing address

760 W FRANKLIN ST
JACKSON MI
49201-2048
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-2700
  • Fax: 517-205-2720
Mailing address:
  • Phone: 517-205-2700
  • Fax: 517-205-2720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number StateMI

VIII. Authorized Official

Name: JEANNE' WICKENS
Title or Position: SR VP FINANCE/CFO
Credential:
Phone: 517-841-6979