NPIMap

Organization Active NPI

W.a. Foote Memorial Hospital, Inc

Doing business as Henry Ford Allegiance Health

  • Pain Medicine Physician
  • Jackson, MI
National Provider Identifier
1407393366
Registry record updated Jan 30, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine PhysicianTaxonomy code 208VP0000X
License
1060000044 Issued in MI
Legal business name
W.A. FOOTE MEMORIAL HOSPITAL, INC
Doing business as
Henry Ford Allegiance Health
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

NPPES NPI Registry

Updated by the provider on Jan 30, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208VP0000X 1060000044 MI Primary

Addresses

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

IdentifierTypeStateIssuer
1760437826MedicaidMI

Other names 1

  • Henry Ford Allegiance Health Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Foote Emerg Phys104 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1485734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1485734400000",
    "number": "1407393366",
    "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": "208VP0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "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": "3",
            "type": "Doing Business As"
        }
    ]
}

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.