1962594317 NPI number — W.A. FOOTE MEMORIAL HOSPITAL, INC.

Table of content: (NPI 1962594317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962594317 NPI number — W.A. FOOTE MEMORIAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W.A. FOOTE MEMORIAL HOSPITAL, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HENRY FORD ALLEGIANCE HEALTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1962594317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 N EAST AVE
Provider Second Line Business Mailing Address:
7TH FL ONE JACKSON SQUARE
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-788-4713
Provider Business Mailing Address Fax Number:
517-841-7419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 N EAST AVE
Provider Second Line Business Practice Location Address:
7TH FL ONE JACKSON SQUARE
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-788-4713
Provider Business Practice Location Address Fax Number:
517-841-7419
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAMSCHRODER
Authorized Official First Name:
ROBIN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EVP, CHIEF FIN & BUS DEV OFFICER
Authorized Official Telephone Number:
313-876-8452

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 045908 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: HL380002 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 5020010 . This is a "PHYSICIAN'S HEALTH PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 00080 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 092063100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2855754 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 030066700 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: P100094 . This is a "PREFERRED CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 01410125 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100094 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 00080 . This is a "BLUE CROSS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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