W A FOOTE MEMORIAL HOSPITAL INC (NPI# 1144883620) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1144883620 |
| Entity Type | Organization |
| Organization Name | W A FOOTE MEMORIAL HOSPITAL INC |
| Practice Address |
205 N East Ave Jackson MI 49201-1753 |
| Mailing Address |
Po Box 67000 Dept 272801 Attn: Provider Enrollment Detroit MI 48267-0001 |
| Practice Telephone | 5172054800 |
| Mailing Telephone | 5172054438 |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2019-04-19 |
| Authorized Official Name | MATTHEW RUSCH (VP REVENUE CYCLE) |
| Authorized Official Telephone | 2163746188 |
| Is Organization Subpart | Y |
| Parent Organization Name | W A FOOTE MEMORIAL HOSPITAL INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | MEDICARE | 0M957250 | 01 |
| Other Name | Type Code |
|---|---|
| Henry Ford Allegiance Health Radiation Oncology | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497250930 | W A Foote Memorial Hospital Inc | Clinic/Center | 810 Hogsback Rd Ste B, Mason, MI 48854-9396 | 2018-03-27 |
| 1235634759 | W A Foote Memorial Hospital Inc | Clinic/Center | 2200 Springport Rd Ste 230, Jackson, MI 49202-1432 | 2018-03-27 |
| 1336644897 | W A Foote Memorial Hospital Inc | Clinic/Center | 3305 Spring Arbor Rd Ste 500, Jackson, MI 49203-3795 | 2018-03-27 |
| 1194220012 | W A Foote Memorial Hospital Inc | Clinic/Center | 415 S Hannah St, Albion, MI 49224 | 2018-03-25 |
| 1144784448 | W A Foote Memorial Hospital Inc | Pathology | 205 N East Ave, Jackson, MI 49201-1753 | 2019-01-31 |
| 1437654977 | W A Foote Memorial Hospital Inc | Clinic/Center | 100 E Michigan Ave Ste 103, Jackson, MI 49201-1406 | 2018-03-27 |
| 1689179103 | W A Foote Memorial Hospital Inc | Clinic/Center | 100 E Michigan Ave Ste 101, Jackson, MI 49201-1406 | 2018-03-27 |
| 1255836763 | W A Foote Memorial Hospital Inc | Clinic/Center | 1401 W North St, Jackson, MI 49202-3135 | 2018-03-27 |
| 1639684137 | W A Foote Memorial Hospital Inc | Registered Nurse | 205 N East Ave, Jackson, MI 49201-1753 | 2017-12-06 |
| 1750304614 | W A Foote Memorial Hospital Inc | Pharmacy | 205 N East Ave, Jackson, MI 49201-1753 | 2006-07-25 |
| Street Address |
205 N EAST AVE |
| City | JACKSON |
| State | MI |
| Zip Code | 49201-1753 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295736015 | Jackson Radiology Consultants, P.C. | Radiology | 205 N East Ave, Imaging Department, Jackson, MI 49201-1753 | 2005-08-02 |
| 1053910356 | Stephanie Galczyk | Physician Assistant | 205 N East Ave, Jackson, MI 49201-1753 | 2020-10-19 |
| 1467050948 | Nicole Elizabeth Knoth | Pharmacist | 205 N East Ave, Jackson, MI 49201-1753 | 2020-10-15 |
| 1952918849 | Jaclyn Nicole Donovan | Nurse Practitioner | 205 N East Ave, Jackson, MI 49201-1753 | 2020-09-25 |
| 1518573732 | Taylor Petersen | Physician Assistant | 205 N East Ave, Jackson, MI 49201-1753 | 2020-09-22 |
| 1790391092 | Ashley Voss | Clinical Nurse Specialist | 205 N East Ave, Jackson, MI 49201-1753 | 2020-09-22 |
| 1902411788 | Owen Jeffrey Wood | Physician Assistant | 205 N East Ave, Jackson, MI 49201-1753 | 2020-09-09 |
| 1669083721 | Holly Jenski Viaches | Occupational Therapist | 205 N East Ave, Jackson, MI 49201-1753 | 2020-08-12 |
| 1205446739 | Sondos Al Khatib | Student in an Organized Health Care Education/Training Program | 205 N East Ave, Jackson, MI 49201-1753 | 2020-08-10 |
| 1003433459 | Kory Ashton Strong | Student in an Organized Health Care Education/Training Program | 205 N East Ave, Jackson, MI 49201-1753 | 2020-07-01 |
| 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 | 2085R0001X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Radiology |
| Specialization | Radiation Oncology |
| A radiologist who deals with the therapeutic applications of radiant energy and its modifiers and the study and management of disease, especially malignant tumors. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Osteopathic Board of Radiology, 2007. http://www.osteopathic.org/certification |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174613830 | Vicksburg Oncology Associates LLC | Radiology | 970 Lakeland Dr Ste 34, Jackson, MS 39216-4640 | 2006-10-13 |
| 1841224433 | Regents of The University of Michigan | Radiology | 1102 East Michigan Ave, Jackson, MI 49201-0010 | 2006-07-10 |
| 1023072485 | Paul D Koerner | Radiology | 322 Hosp Blvd, Cancer Care Center of Jackson, Jackson, TN 38305 | 2006-04-13 |
| 1184607210 | Srinivasan Vijayakumar | Radiology | 350 W Woodrow Wilson Ave, Suite 16, Jackson, MS 39213-7681 | 2005-11-22 |
| 1013919216 | Richard B Friedman | Radiology | 1225 N State St, Jackson, MS 39202-2064 | 2005-06-01 |
| 1518969724 | Steven E Zachow | Radiology | 1850 Chadwick Dr, Jackson, MS 39204-3404 | 2005-06-01 |
| 1497757603 | Sidney A Johnson Jr. | Radiology | 2969 Curran Dr N, Jackson, MS 39216-4121 | 2005-06-01 |
| 1124584800 | Teessa Perekattu Kuruvilla | Radiology | Department of Radiation Oncology, 350 Woodrow Wilson Dr, Jackson, MS 39216-4505 | 2019-02-18 |
| 1194245472 | W. A. Foote Memorial Hospital, Inc | Radiology | 205 N East Ave, Jackson, MI 49201-1753 | 2017-06-27 |
| 1043743339 | Hiba Ahmed | Radiology | 350 W Woodrow Wilson Ave Ste 1600, Jackson, MS 39213-7627 | 2017-04-04 |
| 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.