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General NPI Number Information
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NPI Number | 1215974332
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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 | 05/31/2006
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Last Update Date | 03/06/2024
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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 | DEPARTMENT 272801 PO BOX 67000
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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 | 517-841-7482
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Fax | 517-841-7476
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Authorized Official
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Title or Position | SVP - CMO, CEO - HFA
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Name | MARK SMITH
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Credential | MD
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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 | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | MI
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