Healthcare Provider Details

I. General information

NPI: 1497068639
Provider Name (Legal Business Name): W.A. FOOTE MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 N EAST AVE 7TH FLOOR ONE JACKSON SQUARE
JACKSON MI
49201-1753
US

IV. Provider business mailing address

205 N EAST AVE 7TH FLOOR ONE JACKSON SQUARE
JACKSON MI
49201-1753
US

V. Phone/Fax

Practice location:
  • Phone: 517-788-4800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number StateMI

VIII. Authorized Official

Name: DEBRA WEAVER
Title or Position: MANAGER NUTRITION SERVICES
Credential: RD, MBA
Phone: 517-788-5210