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DSH050121L Adventist Medical Center (Active)
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Main Details
Name
Adventist Medical Center
Subdivision Name
ADVENTIST MEDICAL CENTER - SELMA / Outpatient CT Scanner
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050121L
Medicare Provider Number
050121
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/10/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Adventist Health
Timothy Michael Haydock, CFO
(559) 537-0050
Primary Contact
Adventist Health
Ahmed Abukhazneh, Pharmacist, Charge
(559) 537-2190
Addresses
Street Address
1141 ROSE AVE
SELMA, CA 93662-3241
Billing Address
Adventist Medical Center Hanford
115 Mall Drive
Hanford, CA 93230
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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