Healthcare Provider Details

I. General information

NPI: 1437654977
Provider Name (Legal Business Name): W A FOOTE MEMORIAL HOSPITAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E MICHIGAN AVE STE 103
JACKSON MI
49201-1406
US

IV. Provider business mailing address

PO BOX 67000 DEPT 272801
DETROIT MI
48267-0001
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-7252
  • Fax: 517-205-7253
Mailing address:
  • Phone: 517-205-7843
  • Fax: 517-205-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

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