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DSH110161CR Northside Hospital, Inc. (Active)
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Main Details
Name
Northside Hospital, Inc.
Subdivision Name
Peachtree Dunwoody Outpatient Surgery Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110161CR
Medicare Provider Number
110161
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2017
Participating Start Date
7/1/2017
Participating Approval Date
5/11/2017
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital, Inc.
Judy Gardner, Director of Pharmacy
(404) 851-6793
Addresses
Street Address
5505 Peachtree Dunwoody Road
Suite 150
Atlanta, GA 30342
Billing Address
Northside Hospital - Atlanta, GA
1000 Johnson Ferry Road
Atlanta, GA 30342
Comments
Medicaid Billing
Shipping Addresses
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