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DSH140018C MOUNT SINAI HOSPITAL MEDICAL CENTER (Terminated)
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Main Details
Name
MOUNT SINAI HOSPITAL MEDICAL CENTER
Subdivision Name
HEM/ONC CLINIC @ ARCHER
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH140018C
Medicare Provider Number
140018
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2016
Participating Start Date
4/1/2016
Participating Approval Date
3/31/2016
Last Recertification Date
11/8/2017
Termination Date
Termination Reason
10/1/2018
Site closure
Contacts
Authorizing Official
Mount Sinai Medical Center
Michele Mazurek, Hospital Chief Administator
(773) 257-5021
Primary Contact
Mount Sinai Hospital Medical Center
JUSTIN SCHNEIDER, VICE PRESIDENT CLINICAL OPERATIONS
(773) 257-5048
Addresses
Street Address
6084 South Archer Avenue
Suite 200
Chicago, IL 60638
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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