1073017935 NPI number — W. A. FOOTE MEMORIAL HOSPITAL, INC

Table of content: (NPI 1073017935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073017935 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:
1073017935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/23/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 67000 DEPT 272801
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DETROIT
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48267-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-205-7843
Provider Business Mailing Address Fax Number:
517-205-7419

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 E MICHIGAN AVE STE 102
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:
49201-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-205-4908
Provider Business Practice Location Address Fax Number:
517-205-7233
Provider Enumeration Date:
03/23/2018

Additional Information

Authorized Official

Authorized Official Last Name:
LEONARD
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
Authorized Official Title or Position:
VP FINANCE
Authorized Official Telephone Number:
517-205-7843

Provider Taxonomy Codes

  • Taxonomy code: 261QP2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1053403402 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com