Provider Demographics
NPI:1053403402
Name:W.A. FOOTE MEMORIAL HOSPITAL, INC.
Entity type:Organization
Organization Name:W.A. FOOTE MEMORIAL HOSPITAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EVP, CHIEF FIN & BUS DEV OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAMSCHRODER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:313-876-8452
Mailing Address - Street 1:205 N EAST AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-1753
Mailing Address - Country:US
Mailing Address - Phone:517-788-4800
Mailing Address - Fax:517-796-6450
Practice Address - Street 1:205 N EAST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-1753
Practice Address - Country:US
Practice Address - Phone:517-205-4800
Practice Address - Fax:517-205-7419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI00080OtherBLUE CROSS OF MICHIGAN
MI045908OtherHEALTH ALLIANCE PLAN
MI00080OtherBLUE CARE NETWORK
MI5020010OtherPHYSICIAN'S HEALTH PLAN
MIP100094OtherPREFERRED CARE CHOICES
MI301556349Medicaid
MIHL380002OtherMCARE
MA030066700OtherUNITED MINE WORKERS
MI100094OtherPREFERRED CHOICES
MI100442Medicaid
OH2855754Medicaid
MI100094OtherPREFERRED CHOICES
MI301556349Medicaid
FL092063100Medicaid
MI230092Medicare Oscar/Certification