1053403402 NPI number — W.A. FOOTE MEMORIAL HOSPITAL, INC.

Table of content: (NPI 1053403402)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053403402 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:
Provider Other Organization Name Type Code:
6
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:
1053403402
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2024
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:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49201-1753
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-788-4800
Provider Business Mailing Address Fax Number:
517-796-6450

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 N EAST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49201-1753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-205-4800
Provider Business Practice Location Address Fax Number:
517-205-7419
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: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00080 . This is a "BLUE CROSS OF MICHIGAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 045908 . This is a "HEALTH ALLIANCE 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: 5020010 . This is a "PHYSICIAN'S HEALTH PLAN" identifier , issued by the state of ( MI ) . 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: 301556349 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: HL380002 . This is a "MCARE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 030066700 . This is a "UNITED MINE WORKERS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 100094 . This is a "PREFERRED CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 100442 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




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