Basic Information
| Provider Information | |||||||||
| NPI: | 1194889204 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | W.A. FOOTE MEMORIAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3434 PARMAN RD | ||||||||
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| City: | STOCKBRIDGE | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492859514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5175653215 | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 N EAST AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492011753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5177884800 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | WICKENS | ||||||||
| AuthorizedOfficialFirstName: | JEANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT, FINANCE CFO | ||||||||
| AuthorizedOfficialTelephone: | 5177886979 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 706123 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.