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General NPI Number Information
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NPI Number | 1699212803
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Entity Type | Organization
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Legal Business Name | W.A. FOOTE MEMORIAL HOSPITAL, INC
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Dates
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Enumeration Date | 01/25/2017
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 205 N. EAST AVE ATTN: PROVIDER ENROLLMENT
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City | JACKSON
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State | MI
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Zip | 49201
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Country | US
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Telephone | 517-841-7843
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Fax | 517-841-7419
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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
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Country | US
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Telephone | 517-841-7843
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Fax | 517-841-7419
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Authorized Official
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Title or Position | SVP, CMO, CEO
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Name | MARK SMITH
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Credential |
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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 | 207RC0200X
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Taxonomy Name | Critical Care Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 1060000044
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License Number State | MI
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