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DSH320004F GERALD CHAMPION REGIONAL MEDICAL CTR (Terminated)
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Main Details
Name
GERALD CHAMPION REGIONAL MEDICAL CTR
Subdivision Name
General & Vascular Surgery
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH320004F
Medicare Provider Number
320004
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/14/2015
Participating Start Date
4/1/2015
Participating Approval Date
3/12/2015
Last Recertification Date
8/24/2015
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Otero County Hospital Association
Bashar Naser, CFO
(575) 443-7848 Ext: 5754437841
Primary Contact
Otero County Hospital Association
Bashar Naser, CFO
(575) 443-7848 Ext: 5754437841
Addresses
Street Address
1212 9th Street, Suite C
Alamogordo, NM 88310-5842
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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