Provider Demographics
NPI:1588764989
Name:W. A. FOOTE MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:W. A. FOOTE MEMORIAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-205-7410
Mailing Address - Street 1:205 N. EAST AVE
Mailing Address - Street 2:7TH FL ONE JACKSON SQUARE
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201
Mailing Address - Country:US
Mailing Address - Phone:517-788-4713
Mailing Address - Fax:517-841-7419
Practice Address - Street 1:1125 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1801
Practice Address - Country:US
Practice Address - Phone:517-205-1080
Practice Address - Fax:517-205-1049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:W. A. FOOTE MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-25
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00080OtherBLUE CARE NETWORK
MI405172240Medicaid
MI5020010OtherPHYSICIAN'S HEALTH PLAN
MI100094OtherPREFERRED CHOICES
MI40080OtherBLUE CROSS OF MICHIGAN
MI045908OtherHEALTH ALLIANCE PLAN
MIHL380002OtherMCARE
MIP100094OtherPREFERRED CARE CHOICES
MI030066700OtherUNITED MINE WORKERS
MI100442Medicaid
MIHL380002OtherMCARE
MI030066700OtherUNITED MINE WORKERS
KY01410125Medicaid
MI5020010OtherPHYSICIAN'S HEALTH PLAN