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DSH440065 NorthCrest Medical Center (Terminated)
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Main Details
Name
NorthCrest Medical Center
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH440065
Medicare Provider Number
440065
Additional Details
Current Program Status
Terminated
Registration Date
8/29/2012
Participating Start Date
10/1/2012
Participating Approval Date
9/10/2012
Last Recertification Date
8/6/2015
Termination Date
Termination Reason
7/1/2016
DSH percentage below statutory minimum
Contacts
Authorizing Official
Kim Pridgen, CFO
(615) 384-1515
Primary Contact
Kim Pridgen, CFO
(615) 384-1515
Addresses
Street Address
100 NorthCrest Drive
Springfield, TN 37172
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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