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DSH230072BC HOLLAND HOSPITAL (Active)
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Main Details
Name
HOLLAND HOSPITAL
Subdivision Name
Western Michigan Urological Associates
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230072BC
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 201
Holland, MI 49423
Billing Address
Western Michigan Urological Associates
Dept 77557
DETROIT, MI 48277-0557
Comments
Medicaid Billing
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