Provider Demographics
NPI:1356686349
Name:W. A. FOOTE MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:W. A. FOOTE MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SR VICE PRESIDENT FINANCE/CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:JEANNE'
Authorized Official - Middle Name:M
Authorized Official - Last Name:WICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-841-6979
Mailing Address - Street 1:4400 ANN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2814
Mailing Address - Country:US
Mailing Address - Phone:517-990-0602
Mailing Address - Fax:517-990-0744
Practice Address - Street 1:4400 ANN ARBOR RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2814
Practice Address - Country:US
Practice Address - Phone:517-990-0602
Practice Address - Fax:517-990-0744
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:W. A. FOOTE MEMORIAL HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-12-03
Last Update Date:2016-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy