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DSH110076E DEKALB MEDICAL CENTER, INC - DBA EMORY DECATUR HOSPITAL (Active)
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Main Details
Name
DEKALB MEDICAL CENTER, INC - DBA EMORY DECATUR HOSPITAL
Subdivision Name
Emory Decatur Hospital Cardiac Imaging Center - Cardiac Imaging
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110076E
Medicare Provider Number
110076
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/5/2024
Participating Start Date
10/1/2024
Participating Approval Date
7/19/2024
Last Recertification Date
Contacts
Authorizing Official
Emory Decatur, Emory Hillandale
Lisa Urbistondo, Vice President & CFO
(404) 501-5025
Primary Contact
Emory Healthcare
Sydney Kchao, Corporate Director of Pharmacy, Business Operations and Finance
(404) 686-2147
Addresses
Street Address
2665 N Decatur Rd
Suite 260
Decatur, GA 30033
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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