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DSH110161CZ Northside Hospital, Inc. (Active)
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Main Details
Name
Northside Hospital, Inc.
Subdivision Name
RADIATION ONCOLOGY - LAKE OCONEE - Radiation Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110161CZ
Medicare Provider Number
110161
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/6/2023
Participating Start Date
6/1/2023
Participating Approval Date
4/14/2023
Last Recertification Date
8/12/2024
Contacts
Authorizing Official
Northside Hospital, Inc.
Scott Wade, VP Finance
(404) 303-3381
Primary Contact
Northside Hospital, Inc.
Judy Gardner, Director of Pharmacy
(404) 851-6793
Addresses
Street Address
1000 Cowles Clinic Way
Magnolia Bldg M-200
Sutie 102
Greensboro, GA 30642
Billing Address
Northside Hospital
1000 Johnson Ferry Road
Atlanta, GA 30342
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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