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DSH110143N WELLSTAR COBB HOSPITAL (Terminated)
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Main Details
Name
WELLSTAR COBB HOSPITAL
Subdivision Name
WELLSTAR COBB HOSPITAL ASC VININGS - GENERAL SURGERY
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110143N
Medicare Provider Number
110143
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/9/2019
Participating Start Date
1/1/2020
Participating Approval Date
10/9/2019
Last Recertification Date
Termination Date
Termination Reason
10/1/2020
Business decision by the Covered Entity
Contacts
Authorizing Official
Wellstar Cobb Hospital
Heath Austin King, CFO
(470) 732-5039
Primary Contact
WellStar Health System
Snehal Doshi, SVP Ancillary and Support Svcs
(470) 644-0322
Addresses
Street Address
4441 ATLANTA ROAD SE
302
SMYRNA, GA 30080
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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