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General NPI Number Information
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NPI Number | 1831123728
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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 | 03/06/2024
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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 | 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 | 517-841-7482
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Fax | 517-841-7476
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Authorized Official
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Title or Position | SVP. CMO
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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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 | 207RN0300X
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Taxonomy Name | Nephrology Physician
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number |
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number |
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State | MI
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