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DSH110225D PIEDMONT MOUNTAINSIDE HOSPITAL INC. (Terminated)
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Main Details
Name
PIEDMONT MOUNTAINSIDE HOSPITAL INC.
Subdivision Name
Hyperbaric Center / Wound Care
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110225D
Medicare Provider Number
110225
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/10/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/21/2017
Last Recertification Date
8/22/2018
Termination Date
Termination Reason
1/1/2019
DSH percentage below statutory minimum
Contacts
Authorizing Official
Piedmont Healthcare Multiple Hospital Entities
John G. Miles, Vice President / CFO
(770) 400-2336
Primary Contact
Piedmont Mountainside Hospital
pam Mingo, Director of Pharmacy
(706) 301-5262 Ext: 5262
Addresses
Street Address
620 JL White Drive, Suite 140B
Jasper, GA 30143
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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June 2025
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