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SCH360125-24 Ashtabula County Medical Center (Terminated)
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Main Details
Name
Ashtabula County Medical Center
Subdivision Name
The Ashtabula Clinic - North Kingsville Office
Type
Sole Community Hospital
Rural
Yes
340B ID
SCH360125-24
Medicare Provider Number
360125
Outpatient Facility Provider Number
360125
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/15/2014
Last Recertification Date
8/29/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Ashtabula County Medical Center
Donald L. Kepner, Chief Financial Officer
(440) 997-6912
Primary Contact
Ashtabula County Medical Center
Donald L. Kepner, Chief Financial Officer
(440) 997-6912
Addresses
Street Address
6441 South Main Street
North Kingsville, OH 44068
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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