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General NPI Number Information
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NPI Number | 1073547964
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Entity Type | Organization
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Legal Business Name | WA FOOTE MEMORIAL HOSPITAL, INC
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 205 N EAST AVE
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City | JACKSON
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State | MI
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Zip | 49201-1753
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Country | US
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Telephone | 517-788-4800
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 67000 DEPARTMENT 272801
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City | DETROIT
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State | MI
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Zip | 48267-2728
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Country | US
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Telephone | 517-841-6913
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Fax | 517-841-6917
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Authorized Official
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Title or Position | SVP - CMO, CEO HFAMG EXECUTIVE
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Name | MARK SMITH
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Credential | CFO
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Telephone | 517-205-6407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | MI
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