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DSH110225B PIEDMONT MOUNTAINSIDE HOSPITAL INC. (Terminated)
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Main Details
Name
PIEDMONT MOUNTAINSIDE HOSPITAL INC.
Subdivision Name
PIEDMONT MOUNTAINSIDE HOSPITAL CARDIOVASCULAR IMAGING CENTER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110225B
Medicare Provider Number
110225
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/16/2015
Last Recertification Date
8/22/2018
Termination Date
Termination Reason
1/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Piedmont Healthcare Multiple Hospital Entities
John G. Miles, Vice President / CFO
(770) 400-2336
Primary Contact
Piedmont Mountainside Hospital
pam Mingo, Director of Pharmacy
(706) 301-5262 Ext: 5262
Addresses
Street Address
15 Reinhardt College Parkway, Suite 110B
Canton, GA 30114
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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