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DSH360012B ST. ANN'S HOSP OF COLUMBUS INC, (Terminated)
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Main Details
Name
ST. ANN'S HOSP OF COLUMBUS INC,
Subdivision Name
DIAGNOSTIC RADIOLOGY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360012B
Medicare Provider Number
360012
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/26/2015
Last Recertification Date
8/23/2023
Termination Date
Termination Reason
10/1/2024
Business decision by the Covered Entity
Contacts
Authorizing Official
Mount Carmel Health System
Nicholas Kreatsoulas, Executive Vice President & Chief Clinical Operations Officer
(614) 546-3266
Primary Contact
Mount Carmel Health System
Terrance John Slavin, Regional Director of Reimbursement
(734) 343-3320
Addresses
Street Address
495 COOPER RD
SUITE 100
WESTERVILLE, OH 43081
Billing Address
MOUNT CARMEL HEALTH SYSTEM
3100 Easton Square Place
Suite 300 - Finance
Columbus, OH 43219-6290
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
June 2025
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