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DSH330044BB MVHS, Inc. DBA: Wynn Hospital (Active)
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Main Details
Name
MVHS, Inc. DBA: Wynn Hospital
Subdivision Name
Neuro Science Physician Office
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH330044BB
Medicare Provider Number
330044
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/5/2017
Participating Start Date
7/1/2017
Participating Approval Date
4/26/2017
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
MVHS Inc, DBA Wynn Hospital
Louis Aiello, Sr. VP Finance/ CFO
(315) 917-8213
Primary Contact
MVHS, Inc. DBA: Wynn Hospital
James Humphrey, AVP Finance/ Controller
(315) 801-4326
Addresses
Street Address
1658 Champlin Ave.
Utica, NY 13502
Billing Address
Faxton St. Luke's Healthcare
1676 Sunset Ave.
Utica, NY 13502
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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