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DSH230072AT HOLLAND HOSPITAL (Active)
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Main Details
Name
HOLLAND HOSPITAL
Subdivision Name
Ear, Nose, Throat & Allergy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230072AT
Medicare Provider Number
230072
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/5/2016
Participating Start Date
10/1/2016
Participating Approval Date
8/22/2016
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Holland Hospital
Mark Pawlak, President
(616) 392-5141
Primary Contact
Holland Hospital
Zachary C Tamminga, Director Finance Administration
(616) 395-4472
Addresses
Street Address
577 Michigan Ave
Suite 101
Holland, MI 49423
Billing Address
Ear, Nose, Throat & Allergy
Dept 77557
DETROIT, MI 48277-0557
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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