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DSH110161DV Northside Hospital, Inc. (Active)
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Main Details
Name
Northside Hospital, Inc.
Subdivision Name
RAD-MRI & IMAGING OF HABERSHAM - Radiology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110161DV
Medicare Provider Number
110161
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/16/2024
Participating Start Date
4/1/2024
Participating Approval Date
3/5/2024
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital, Inc.
Judy Gardner, Director of Pharmacy
(404) 851-6793
Addresses
Street Address
638 Historic Highway 441 North
Suite D
Demorest, GA 30535
Billing Address
Northside Hospital
1000 Johnson Ferry Rd
Atlanta, GA 30342
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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