Wa Foote Memorial Hospital Inc
Organization Active NPI Family Medicine Physician · Jackson, MI
NPI 1962953034 · NPPES record last updated Mar 6, 2024
Key facts
- NPI
- 1962953034
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 1060000044 (MI)
- Legal business name
- WA FOOTE MEMORIAL HOSPITAL INC
- Practice address
- 205 N East Ave
Jackson, MI 49201-1753 - Phone
- (517) 205-7843
- NPI assigned
- Oct 24, 2016
- Organization subpart
- Yes
- Parent organization (as reported)
- HENRY FORD HEALTH SYSTEM
Authorized official
- Name
- Mark Smith
- Title
- SVP, Cmo
- Phone
- (517) 205-6407
Corporate family (same tax ID) 15
Practitioners 31
-
Rene Cardenas, MD
-
Pauline Chiu, M.D.
-
Michael David Collins, M.D.
-
Katherine A Cox, DO
-
Mohamed El Fakiy, MD
-
Michael A Foust, M.D.
-
Athar Ghannam, MD
-
Patricia S Hoffman, M.D.
-
Laith Khalil, DO
-
Kanika Khindria, MD
-
David A. Kolde, MD
-
Maria Opolka, DO
-
Stanley J Sczecienski, D.O.
-
Scott Shelton, D.O.
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
- Part of
- Henry for Hospital
Locations
1201 E Michigan Ave
Ste 300
Jackson, MI 49201
Phone (517) 205-1431
130 N Sherman St
Leslie, MI 49251
Phone (517) 205-2500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 1060000044 | MI | Yes |
| Sports Medicine (Family Medicine) Physician |
207QS0010X |
Addresses
Primary practice location
205 N East Ave
Jackson, MI 49201-1753
Mailing address
PO Box 64787 # 64000
Detroit, MI 48264-0001
Phone (517) 205-7843
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215974332 | Medicaid | MI |
Other names
- Henry Ford Allegiance Health
Other providers in Jackson, MI
- Wa Foote Memorial Hospital
- Wa Foote Memorial Hospital
- Wa Foote Memorial Hospital
- Wa Foote Memorial Hospital
- Wa Foote Memorial Hospital Inc
- Wa Foote Memorial Hospital Inc.
- Wa Foote Memorial Hospital Inc.
- Wa Foote Memorial Hospital Inc.
- Wa Foote Memorial Hospital Inc.
- Wa Foote Memorial Hospital, Inc
All providers in Jackson, MI · Family Medicine 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.