NPIMap

W. a. Foote Memorial Hospital, Inc

Organization Active NPI Clinical Medical Laboratory · Grass Lake, MI

NPI 1861996753 · NPPES record last updated Mar 23, 2018

Key facts

NPI
1861996753
Entity type
Organization (NPI type 2)
Primary specialty
Clinical Medical Laboratory 291U00000X
Legal business name
W. A. FOOTE MEMORIAL HOSPITAL, INC
Practice address
12369 E Michigan Ave
Grass Lake, MI 49240-9213
Phone
(517) 205-2539
Fax
(517) 205-0105
NPI assigned
Mar 23, 2018
Organization subpart
No

Authorized official

Name
Kevin Leonard
Title
VP Finance
Phone
(517) 205-7843

Corporate family (same tax ID) 24

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

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D1020436Henry Ford Jackson-Grass Lake
12369 E Michigan Avenue, Grass Lake, MI 49240		Certificate of waiverDec 18, 2027

National Provider Directory

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

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X Yes

Addresses

Primary practice location

12369 E Michigan Ave
Grass Lake, MI 49240-9213

Mailing address

PO Box 67000 Dept 272801
Detroit, MI 48267-0001
Phone (517) 205-7843

Other names

  • Henry Ford Allegiance Health Doing business as

Other providers in Grass Lake, MI

All providers in Grass Lake, MI · Clinical Medical Laboratory in Michigan

Sources for this page

Verify at the official NPI Registry.