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DSH360035AZ MOUNT CARMEL HEALTH (Terminated)
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Main Details
Name
MOUNT CARMEL HEALTH
Subdivision Name
East Enterostomal Therapy
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH360035AZ
Medicare Provider Number
360035
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/11/2017
Participating Start Date
4/1/2017
Participating Approval Date
3/13/2017
Last Recertification Date
8/25/2021
Termination Date
Termination Reason
10/1/2022
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Mount Carmel Health System
Nicholas Kreatsoulas, Executive Vice President & Chief Clinical Operations Officer
(614) 546-3266
Primary Contact
Mount Carmel Health System
Terrance John Slavin, Regional Director of Reimbursement
(734) 343-3320
Addresses
Street Address
6001 E Broad St
Columbus, OH 43213-1502
Billing Address
Mount Carmel Health System
6150 E Broad St
3rd Floor Finance
Columbus, OH 43213-1574
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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