Healthcare Provider Details

I. General information

NPI: 1306174982
Provider Name (Legal Business Name): WA FOOTE MEMORIAL HOSPITAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2009
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 E MICHIGAN AVE SUITE 110
JACKSON MI
49201-1852
US

IV. Provider business mailing address

700 E MICHIGAN AVE
JACKSON MI
49201-1626
US

V. Phone/Fax

Practice location:
  • Phone: 517-817-7638
  • Fax: 517-817-7636
Mailing address:
  • Phone: 517-768-8873
  • Fax: 517-780-3816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number380010
License Number StateMI

VIII. Authorized Official

Name: JEANNE' WICKENS
Title or Position: SR. VICE PRESIDENT, FINANCE CFO
Credential:
Phone: 517-788-6979