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DSH390142X ALBERT EINSTEIN MEDICAL CENTER (Active)
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Main Details
Name
ALBERT EINSTEIN MEDICAL CENTER
Subdivision Name
Gastroenterology Procedures
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH390142X
Medicare Provider Number
390142
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/3/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/20/2017
Last Recertification Date
8/26/2024
Contacts
Authorizing Official
Jefferson Health
Walter Wyatt, VP-Finance
(215) 254-3254
Primary Contact
Jefferson Health
Dustin Ottemiller, VP, Finance
(215) 503-5219
Addresses
Street Address
1200 West Tabor Road
2nd Floor
Philadelphia, PA 19141
Billing Address
Albert Einstein Medical Center
5501 Old York Road
Philadelphia, PA 19141
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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