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DSH390174E THOMAS JEFFERSON UNIVERSITY HOSPITAL (Active)
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Main Details
Name
THOMAS JEFFERSON UNIVERSITY HOSPITAL
Subdivision Name
Jefferson Infusion Center at Methodist
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390174E
Medicare Provider Number
390174
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/10/2012
Participating Start Date
1/1/2013
Participating Approval Date
11/27/2012
Last Recertification Date
9/6/2024
Contacts
Authorizing Official
Jefferson Health
Walter Wyatt, VP-Finance
(215) 254-3254
Primary Contact
Jefferson Health
Dustin Ottemiller, VP, Finance
(215) 503-5219
Addresses
Street Address
1300 Wolf Street
3rd Floor
Philadelphia, PA 19148
Billing Address
Thomas Jefferson University Hospitals- Methodist Hospital Division
2301 S Broad Street
Philadelphia, PA 19148
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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