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DSH100088S BAPTIST MEDICAL CENTER (Terminated)
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Main Details
Name
BAPTIST MEDICAL CENTER
Subdivision Name
Imaging Center Building-Cat Scan
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH100088S
Medicare Provider Number
100088
Outpatient Facility Provider Number
100088
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2014
Participating Start Date
10/1/2014
Participating Approval Date
9/3/2014
Last Recertification Date
Termination Date
Termination Reason
7/1/2015
Other
Contacts
Authorizing Official
Baptist Medical Center
Scott M. Wooten, SVP & CFO
(904) 202-3405
Primary Contact
Baptist Medical Center
Scott M. Wooten, SVP & CFO
(904) 202-3405
Addresses
Street Address
1771 Baptist Clay Drive
Fleming Island, FL 32003
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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