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DSH390223D PENN PRESBYTERIAN MEDICAL CENTER (Active)
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Main Details
Name
PENN PRESBYTERIAN MEDICAL CENTER
Subdivision Name
Mayfair Cardiology
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH390223D
Medicare Provider Number
390223
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/1/2013
Participating Start Date
10/1/2013
Participating Approval Date
7/9/2013
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Penn Presbyterian Medical Center
Gene Gofman, Chief Financial Officer
(215) 662-9863
Primary Contact
Penn Presbyterian Medical Center
Justin Kuratnick, Director of Pharmacy
(215) 662-9291
Addresses
Street Address
7133 Roosevelt Blvd
Philadelphia, PA 19149
Billing Address
PENN Presbyterian Medical Center
51 North 39th Street
Philadelphia, PA 19104
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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