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DSH230072BE HOLLAND HOSPITAL (Active)
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Main Details
Name
HOLLAND HOSPITAL
Subdivision Name
Lifestyle Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH230072BE
Medicare Provider Number
230072
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/11/2018
Participating Start Date
10/1/2018
Participating Approval Date
7/17/2018
Last Recertification Date
9/4/2024
Contacts
Authorizing Official
Holland Hospital
Mark Pawlak, President
(616) 392-5141
Primary Contact
Holland Hospital
Zachary C Tamminga, Director Finance Administration
(616) 395-4472
Addresses
Street Address
175 S Waverly
Suite A
Holland, MI 49423
Billing Address
Lifestyle Medicine
Dept 77557
DETROIT, MI 48277-0557
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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