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DSH230072AW HOLLAND HOSPITAL (Terminated)
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Main Details
Name
HOLLAND HOSPITAL
Subdivision Name
Foot & Ankle
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230072AW
Medicare Provider Number
230072
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/5/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/23/2016
Last Recertification Date
9/8/2022
Termination Date
Termination Reason
7/1/2023
Site closure
Contacts
Authorizing Official
Holland Hospital
Mark Pawlak, President
(616) 392-5141
Primary Contact
Holland Hospital
Carol Fletcher, Sr. Director Revenue Integrity
(616) 394-3227
Addresses
Street Address
3299 N Wellness Drive
Suite 150
Holland, MI 49424
Billing Address
Foot & Ankle
Dept 77557
DETROIT, MI 48277-0557
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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