W.A. FOOTE MEMORIAL HOSPITAL, INC (NPI# 1134666936) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1134666936 |
| Entity Type | Organization |
| Organization Name | W.A. FOOTE MEMORIAL HOSPITAL, INC |
| Other Organization Name | HENRY FORD ALLEGIANCE HEALTH |
| Practice Address |
205 N. East Ave Jackson MI 49201 |
| Mailing Address |
Po Box 67000 Department 272801 Detroit MI 48267 |
| Practice Telephone | 5172057843 |
| Practice Fax Number | 5178417419 |
| Mailing Telephone | 5178417843 |
| Mailing Fax Number | 5178417419 |
| Enumeration Date | 2017-01-31 |
| Last Update Date | 2017-03-01 |
| Authorized Official Name | KEVIN LEONARD (VP FINANCE) |
| Authorized Official Telephone | 5178417843 |
| Is Organization Subpart | Y |
| Parent Organization Name | HENRY FORD ALLEGIANCE HEALTH GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 1060000044 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | 1760437826 | 05 |
| Other Name | Type Code |
|---|---|
| Henry Ford Allegiance Health | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255878062 | W.a. Foote Memorial Hospital, Inc | Otolaryngology | 205 N.east Ave, Jackson, MI 49201 | 2017-01-31 |
| 1023512936 | W.a. Foote Memorial Hospital, Inc | Clinical Medical Laboratory | 4304 Page Ave, Michigan Center, MI 49254-1078 | 2018-03-23 |
| 1306386586 | W.a. Foote Memorial Hospital, Inc | Surgery | 205 N East Ave, Jackson, MI 49201-1753 | 2017-03-07 |
| 1073051199 | W.a. Foote Memorial Hospital, Inc | Hospitalist | 205 N. East Ave, Attn: Provider Enrollment, Jackson, MI 49201 | 2017-02-09 |
| 1912445677 | W.a. Foote Memorial Hospital, Inc | Psychiatry & Neurology | 205 N. East Ave, Jackson, MI 49201 | 2017-02-02 |
| 1649717448 | W.a. Foote Memorial Hospital, Inc | Surgery | 205 N. East Ave., Jackson, MI 49201 | 2017-01-31 |
| 1538606348 | W.a. Foote Memorial Hospital, Inc | Internal Medicine | 205 N. East Ave, Jackson, MI 49201 | 2017-01-31 |
| 1891232740 | W.a. Foote Memorial Hospital, Inc | Pediatrics | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| 1356888218 | W.a. Foote Memorial Hospital, Inc | Internal Medicine | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| 1235676180 | W.a. Foote Memorial Hospital, Inc | Physician Assistant | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| Street Address |
205 N. EAST AVE |
| City | JACKSON |
| State | MI |
| Zip Code | 49201 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780776138 | W.a. Foote Memorial Hospital, Inc. | Clinic/Center | 205 N. East Ave, 7th Fl One Jackson Square, Jackson, MI 49201 | 2006-09-29 |
| 1528620366 | Maha Mahesh Bayya | Student in an Organized Health Care Education/Training Program | 205 N. East Ave, Gme - 2nd Floor Cab, Jackson, MI 49201-1753 | 2019-07-02 |
| 1558856187 | Narine Shirvanian | Student in an Organized Health Care Education/Training Program | 205 N. East Ave, 2nd Floor Anderson Building, Jackson, MI 49201 | 2018-06-26 |
| 1255861241 | Michael Doyle | Student in an Organized Health Care Education/Training Program | 205 N. East Ave, Jackson, MI 49201 | 2017-06-13 |
| 1073051199 | W.a. Foote Memorial Hospital, Inc | Hospitalist | 205 N. East Ave, Attn: Provider Enrollment, Jackson, MI 49201 | 2017-02-09 |
| 1912445677 | W.a. Foote Memorial Hospital, Inc | Psychiatry & Neurology | 205 N. East Ave, Jackson, MI 49201 | 2017-02-02 |
| 1538606348 | W.a. Foote Memorial Hospital, Inc | Internal Medicine | 205 N. East Ave, Jackson, MI 49201 | 2017-01-31 |
| 1891232740 | W.a. Foote Memorial Hospital, Inc | Pediatrics | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| 1356888218 | W.a. Foote Memorial Hospital, Inc | Internal Medicine | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| 1235676180 | W.a. Foote Memorial Hospital, Inc | Physician Assistant | 205 N. East Ave, Jackson, MI 49201 | 2017-01-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174137863 | Sally Ann Shaw | Behavior Technician | 3699 Miles Rd., Jackson, MI 49201 | 2020-09-01 |
| 1780293043 | Alyn Kristin Kay | Technician | Hope Network-hope's Door Cru, 3699 Miles Rd., Jackson, MI 49201 | 2020-07-23 |
| 1841827946 | Maverick Jubane | Student in an Organized Health Care Education/Training Program | Henry Ford Allegiance Health, 205 N East Avenue, Jackson, MI 49201 | 2020-03-26 |
| 1306486584 | Cody Williams | Technician, Other | 1001 Laurence Avenue St E, Jackson, MI 49201 | 2020-01-15 |
| 1720632292 | Krystie Lynn Adorjan | Speech-Language Pathologist | 1175 W Parnall Rd, Jackson, MI 49201 | 2019-08-01 |
| 1407412653 | Howard Franklin Tanner II | Speech-Language Pathologist | 102 East Michigan Avenue, Jackson, MI 49201 | 2019-05-14 |
| 1356863740 | Rima Zarar Qayyum | Speech-Language Pathologist | 4800 Firethorn Dr., Jackson, MI 49201 | 2017-07-07 |
| 1306384383 | Briana Nesmith | Speech-Language Pathologist | 2025 Ann Arbor Road, Jackson, MI 49201 | 2017-02-09 |
| 1255878062 | W.a. Foote Memorial Hospital, Inc | Otolaryngology | 205 N.east Ave, Jackson, MI 49201 | 2017-01-31 |
| 1306212881 | Aisha Henderson | Social Worker | 729 West Michigan Avenue, Jackson, MI 49201 | 2015-08-19 |
| Find all providers in zip 49201 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427408319 | Advanced Dermatology of Wyoming, Inc | Dermatology | 62 South Redmond Street, Jackson, WY 83001-8664 | 2016-06-21 |
| 1871814095 | Elizabeth Anne Gordon Spratt | Dermatology | 3333 Spring Arbor Rd Ste 500, Jackson, MI 49203-8605 | 2010-06-22 |
| 1962644013 | Virginia Anne Koubek | Dermatology | 87 Murray Guard Dr Ste B, Jackson, TN 38305-3775 | 2009-04-02 |
| 1053532226 | Julie P Wyatt | Dermatology | 3000 Old Canton Rd Ste 430, Jackson, MS 39216 | 2007-05-02 |
| 1265653745 | Brittany Wilson Baker | Dermatology | 984 W Broadway, Suite 4, Jackson, WY 83001-0000 | 2007-05-01 |
| 1982705570 | Louis Julian Wise Jr. | Dermatology | 3000 Old Canton Road, Suite 430, Jackson, MS 39216 | 2006-09-26 |
| 1215940937 | Sterling Ruffin Craig | Dermatology | 2817 North Highland Avenue, Suite A, Jackson, TN 38305-1789 | 2006-08-14 |
| 1366459026 | Chemene Quinn | Dermatology | 501 Marshall St Ste 406, Dermatology Consultants, Pllc, Jackson, MS 39202-1650 | 2006-08-02 |
| 1609893296 | Kenneth R. Maloney | Dermatology | 294 Summar Drive, Jackson, TN 38301 | 2006-07-17 |
| 1720039423 | William P Teer | Dermatology | 1320 Union University Dr, Jackson, TN 38305-3780 | 2006-05-15 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.