NPIMap

Organization Active NPI

W.a. Foote Memorial Hospital, Inc

  • Hematology (Internal Medicine) Physician
  • Jackson, MI
National Provider Identifier
1043757909
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology (Internal Medicine) PhysicianTaxonomy code 207RH0000X
License
1060000044 Issued in MI
Legal business name
W.A. FOOTE MEMORIAL HOSPITAL, INC
Practice address
205 N. East Ave
Jackson, MI 49201
Phone
(517) 841-7843
Fax
(517) 841-7419
NPI assigned
Jan 30, 2017
Organization subpart
Yes
Parent organization
HENRY FORD ALLEGIANCE HEALTH GROUPAs reported in NPPES

Authorized official

NPPES NPI Registry
Name
Kevin Leonard
Title
VP Finance
Phone
(517) 841-7843

Corporate family (same tax ID) 14

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

National Provider Directory
Tax ID family
Foote Emerg Phys (104 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Hematology (Internal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RH0000X 1060000044 MI Primary

Addresses

NPPES NPI Registry

Primary practice location

205 N. East Ave
Jackson, MI 49201

Mailing address

PO Box 67000
Department 272801
Detroit, MI 48267
Phone (517) 841-7843

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
1760437826MedicaidMI

Other names 1

NPPES NPI Registry
  • Henry Ford Allegiance Health Former legal business name

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jan 30, 2017.

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1043757909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 67000",
            "address_2": "DEPARTMENT 272801",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "48267",
            "telephone_number": "517-841-7843",
            "fax_number": "517-841-7419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N. EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49201",
            "telephone_number": "517-841-7843",
            "fax_number": "517-841-7419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "W.A. FOOTE MEMORIAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HENRY FORD ALLEGIANCE HEALTH GROUP",
        "enumeration_date": "2017-01-30",
        "last_updated": "2017-01-30",
        "status": "A",
        "authorized_official_last_name": "LEONARD",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "517-841-7843"
    },
    "taxonomies": [
        {
            "code": "207RH0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Hematology",
            "state": "MI",
            "license": "1060000044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760437826",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Henry Ford Allegiance Health",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.