Healthcare Provider Details

I. General information

NPI: 1780776138
Provider Name (Legal Business Name): W.A. FOOTE MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 04/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N. EAST AVE 7TH FL ONE JACKSON SQUARE
JACKSON MI
49201
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: 517-788-4713
  • Fax: 517-841-7419
Mailing address:
  • Phone: 517-788-4713
  • Fax: 517-841-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number State

VIII. Authorized Official

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