Healthcare Provider Details

I. General information

NPI: 1598857948
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: 03/06/2024
Certification Date: 03/06/2024
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 Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: MRS. MARK SMITH
Title or Position: SVP, CMO
Credential:
Phone: 517-205-6407