Healthcare Provider Details

I. General information

NPI: 1588764989
Provider Name (Legal Business Name): W. A. FOOTE MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 E MICHIGAN AVE
JACKSON MI
49201-1801
US

IV. Provider business mailing address

205 N. EAST AVE 7TH FL ONE JACKSON SQUARE
JACKSON MI
49201
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-1080
  • Fax: 517-205-1049
Mailing address:
  • Phone: 517-788-4713
  • Fax: 517-841-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KEVIN LEONARD
Title or Position: VP FINANCE
Credential:
Phone: 517-205-7410