Organization · Type 2 NPI

W.a. Foote Memorial Hospital

Vascular Surgery Physician · Jackson, MI

NPI number 1124565098 Active

Practice location

205 N. East Ave
Jackson, MI 49201

Call (517) 841-7843 Map

Fax (517) 841-7419

Mailing address

PO Box 670884
Detroit, MI 48267-0884

Specialties and licenses

Taxonomy	Code	License
Vascular Surgery Physician Primary	2086S0129X	1060000044 (MI)

Vascular Surgery Physician: A surgeon with expertise in the management of surgical disorders of the blood vessels, excluding the intracranial vessels or the heart.

42 other providers at this address

Other vascular surgery physician providers in Jackson

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NPI record

NPI: 1124565098
Entity type: Organization (Type 2)
Issued: Jan 30, 2017
Last updated: Oct 22, 2026
Status: Active

Other names

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Henry Ford Allegiance Health · doing business as
Henry Ford Allegiance Health · doing business as
Henry Ford Jackson Health · doing business as

Authorized official

Kimberly Cebalt
Director
(313) 874-6764

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1124565098

W.a. Foote Memorial Hospital's National Provider Identifier is 1124565098, issued on Jan 30, 2017. The primary taxonomy on file is Vascular Surgery Physician (2086S0129X), and the practice location is in Jackson, MI. The record was last updated on Oct 22, 2026.