1265528939 NPI number — W.A. FOOTE MEMORIAL HOSPITAL, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265528939 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:
1265528939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2016
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:
10/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WICKENS
Authorized Official First Name:
JEANNE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
SR VP FINANCE/CFO
Authorized Official Telephone Number:
517-841-6979

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: 01410125 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 045908 . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 2855754 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 405172240 , issued by the state of ( MI ) . 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: 100442 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00080 . This is a "BLUE CROSS OF MICHIGAN" 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: 030066700 . This is a "UNITED MINE WORKERS" 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: P100094 . This is a "PREFERRED CARE CHOICES" identifier , issued by the state of ( MI ) . 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".




Copyright © 2007-2025 www.npivalidator.com