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DSH110095A TIFT REGIONAL HEALTH SYSTEM, INC (Active)
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Main Details
Name
TIFT REGIONAL HEALTH SYSTEM, INC
Subdivision Name
Anita Stewart Oncology Center
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH110095A
Medicare Provider Number
110095
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2012
Participating Start Date
7/1/2012
Participating Approval Date
4/30/2012
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Tift Regional Health System
Troy Buren Brooks, SVP/CFO
(229) 353-3397
Primary Contact
Tift Regional Health System, Inc.
Robert Evan Nix, Director of Pharmacy
(229) 353-6298
Addresses
Street Address
1623 Madison Ave
Tifton, GA 31794
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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April 2025
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