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DSH110161BE Northside Hospital, Inc. (Active)
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Main Details
Name
Northside Hospital, Inc.
Subdivision Name
Northside Douglasville Imaging
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110161BE
Medicare Provider Number
110161
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/29/2016
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital, Inc.
Judy Gardner, Director of Pharmacy
(404) 851-6793
Addresses
Street Address
4586 Timber Ridge Drive
Suite 100
Douglasville, GA 30135
Billing Address
Northside Hospital
1000 Johnson Ferry Road
Atlanta, GA 30342
Comments
Medicaid Billing
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Contract Pharmacies
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