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DSH110161DJ Northside Hospital, Inc. (Active)
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Main Details
Name
Northside Hospital, Inc.
Subdivision Name
Radiation Oncology Macon - Radiation Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH110161DJ
Medicare Provider Number
110161
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/14/2023
Participating Start Date
6/1/2023
Participating Approval Date
4/18/2023
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
308 Coliseum Drive
Suite 100
Macon, GA 31217
Billing Address
Northside Hospital
1000 Johnson Ferry Road
Atlanta, GA 30342
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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