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DSH330044U Faxton St. Luke's Healthcare (Terminated)
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Main Details
Name
Faxton St. Luke's Healthcare
Subdivision Name
Recovery Room Faxton
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330044U
Medicare Provider Number
330044
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
5/10/2014
Participating Start Date
7/1/2014
Participating Approval Date
5/22/2014
Last Recertification Date
11/27/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
MVHS Inc, DBA Wynn Hospital
Louis Aiello, Sr. VP Finance/ CFO
(315) 917-8213
Primary Contact
MVHS, Inc. DBA: Wynn Hospital
James Humphrey, AVP Finance/ Controller
(315) 801-4326
Addresses
Street Address
1676 Sunset Ave.
Utica, NY 13502
Billing Address
Faxton St. Luke's Healthcare
PO Box 479
Utica, NY 13503
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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