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General NPI Number Information
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NPI Number | 1750304614
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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 | 07/25/2006
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Last Update Date | 07/21/2022
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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 | 517-205-4907
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Fax | 517-205-5947
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Provider Business Mailing 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 | 517-788-4907
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Fax | 517-789-5947
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Authorized Official
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Title or Position | VP FINANCE
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Name | KEVIN M. LEONARD
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Credential |
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Telephone | 517-205-7843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 5301010159
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License Number State | MI
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