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DSH110225E PIEDMONT MOUNTAINSIDE HOSPITAL INC. (Terminated)
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Main Details
Name
PIEDMONT MOUNTAINSIDE HOSPITAL INC.
Subdivision Name
PIEDMONT MOUNTAINSIDE HOSPITAL - ELLIJAY Free Standing ED
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110225E
Medicare Provider Number
110225
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/10/2018
Participating Start Date
4/1/2018
Participating Approval Date
1/25/2018
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
1360 SOUTH MAIN STREET
ELLIJAY, GA 30540
Billing Address
PIEDMONT MOUNTAINSIDE HOSPITAL - ELLIJAY
1266 HIGHWAY 515 SOUTH
JASPER, GA 30143
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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