W.a. Foote Memorial Hospital, Inc
Organization Active NPI Plastic and Reconstructive Surgery Physician · Jackson, MI
NPI 1780121970 · NPPES record last updated Mar 6, 2024
Key facts
- NPI
- 1780121970
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Plastic and Reconstructive Surgery Physician 2086S0122X
- License
- 1060000044 (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 25, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- HENRY FORD ALLEGIANCE HEALTH GROUP
Authorized official
- Name
- Mark Smith
- Title
- SVP, Cmo, Ceo
- Phone
- (517) 205-6407
Corporate family (same tax ID) 24
Practitioners 5
-
Diana Marie Flis, M.D.
-
Rachel Campbell Hooper, M.D.
-
Kristoffer Bradley Sugg, MD, PHD
-
Kristin Halsell, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031212000691 | MI | Part B Supplier - Clinic/Group Practice | 0244136067 |
Receives reassigned benefits from 485 practitioners This NPI is an additional NPI on the enrollment Practice locations: Jackson, MI; Albion, MI; Jonesville, MI; Leslie, MI; Marshall, MI; Mason, MI; Onsted, MI; Spring Arbor, MI… |
National Provider Directory
- Tax ID family
- Foote Emerg Phys
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic and Reconstructive Surgery Physician |
2086S0122X | 1060000044 | MI | Yes |
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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760437826 | Medicaid | MI |
Other names
- Henry Ford Allegiance Health
Other providers in Jackson, MI
- W.a. Foote Memorial Hospital, Inc
- W.a. Foote Memorial Hospital, Inc
- W.a. Foote Memorial Hospital, Inc
- W.a. Foote Memorial Hospital, Inc
- W.a. Foote Memorial Hospital, Inc
- W.a. Foote Memorial Hospital, Inc
- W.a. Foote Memorial Hospital, Inc
- W.a. Foote Memorial Hospital, Inc
- W.a. Foote Memorial Hospital, Inc
- W.a. Foote Memorial Hospital, Inc
All providers in Jackson, MI · Plastic and Reconstructive Surgery Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.