Basic Information
| Provider Information | |||||||||
| NPI: | 1265806343 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WA FOOTE MEMORIAL HOSPITAL INC. | ||||||||
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| OtherOrganizationName: | HENRY FORD ALLEGINACE HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 760 W FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172052700 | ||||||||
| FaxNumber: | 5172052720 | ||||||||
| Practice Location | |||||||||
| Address1: | 760 W FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | JACKSON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 492012048 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5172052700 | ||||||||
| FaxNumber: | 5172052720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2015 | ||||||||
| LastUpdateDate: | 04/01/2016 | ||||||||
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| AuthorizedOfficialLastName: | WICKENS | ||||||||
| AuthorizedOfficialFirstName: | JEANNE' | ||||||||
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| AuthorizedOfficialTitleorPosition: | SR VP FINANCE/CFO | ||||||||
| AuthorizedOfficialTelephone: | 5178416979 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | WA FOOTE MEMORIAL HOSPITAL INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.