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DSH670077C HOUSTON METHODIST WEST HOSPITAL (Active)
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Main Details
Name
HOUSTON METHODIST WEST HOSPITAL
Subdivision Name
HOUSTON METHODIST WEST BREAST CENTE - Breast Center-Radiology Diagnostic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH670077C
Medicare Provider Number
670077
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/8/2022
Participating Start Date
10/1/2022
Participating Approval Date
9/1/2022
Last Recertification Date
8/15/2024
Contacts
Authorizing Official
Houston Methodist West Hospital
Kyle R Stanzel, VP & Chief Operating Officer
(832) 522-0300
Primary Contact
Houston Methodist
Daniel Metzen, System Director of Pharmacy
(713) 441-2141
Addresses
Street Address
18300 KATY FWY
STE 125
HOUSTON, TX 77094-1520
Billing Address
Houston Methodist West Hospital
18500 KATY FWY
Houston, TX 77094
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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