Healthcare Provider Details

I. General information

NPI: 1124523915
Provider Name (Legal Business Name): W. A. FOOTE MEMORIAL HOSPITAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MICHIGAN AVE
JACKSON MI
49201-2457
US

IV. Provider business mailing address

PO BOX 67000
DETROIT MI
48267-0002
US

V. Phone/Fax

Practice location:
  • Phone: 517-205-2101
  • Fax: 517-205-0122
Mailing address:
  • Phone: 517-205-7843
  • Fax: 517-205-7419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: KEVIN LEONARD
Title or Position: VP FINANCE
Credential:
Phone: 517-205-7843