Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 1

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Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 1 Provider ID Hospital Name Address City State ZIP Telephone County 10001 SOUTHEAST ALABAMA MEDICAL CENTER 1108 ROSS CLARK CIRCLE DOTHAN AL 36302 (334) 793-8111 340 10005 MARSHALL MEDICAL CENTER SOUTH 2505 U S HIGHWAY 431 NORTH BOAZ AL 35957 (256) 593-8310 470 10006 ELIZA COFFEE MEMORIAL HOSPITAL 205 MARENGO STREET FLORENCE AL 35631 (256) 768-9191 380 10007 MIZELL MEMORIAL HOSPITAL 702 MAIN ST OPP AL 36467 (334) 493-3541 190 10008 CRENSHAW COMMUNITY HOSPITAL 101 HOSPITAL CIRCLE LUVERNE AL 36049 (334) 335-3374 200 10009 HARTSELLE MEDICAL CENTER 201 PINE STREET NORTHWEST HARTSELLE AL 35640 (256) 773-6511 510 10010 MARSHALL MEDICAL 8000 ALABAMA HIGHWAY 69 GUNTERSVILLE AL 35976 (256) 753-8000 470 10011 MEDICAL CENTER EAST INC 50 MEDICAL PARK EAST DRIVE BIRMINGHAM AL 35235 (205) 838-3103 360 10012 BAPTIST MEDICAL CENTER DEKALB 200 MED CENTER DRIVE FORT PAYNE AL 35968 (256) 845-3150 240 10015 THOMASVILLE INFIRMARY 33700 HIGHWAY 43 THOMASVILLE AL 36784 (334) 636-4431 120 10016 SHELBY BAPTIST MEDICAL CENTER 1000 FIRST STREET NORTH ALABASTER AL 35007 (205) 620-8130 580 10018 CALLAHAN EYE FOUNDATION HOSPITAL 1720 UNIVERSITY BLVD BIRMINGHAM AL 35233 (205) 325-8100 360 10019 HELEN KELLER MEMORIAL HOSPITAL 1300 SOUTH MONTGOMERY AVENUE SHEFFIELD AL 35660 (256) 386-4556 360 10021 DALE MED CTR GER PSY UNIT NEW DAY SENI 126 HOSPITAL AVE OZARK AL 36360 (334) 774-2601 220 10022 BAPTIST MEDICAL CENTER CHEROKEE 400 NORTHWOOD DR CENTRE AL 35960 (256) 927-5531 90 10023 BAPTIST HEALTH DBA BAPTIST MED CTR SOU 2105 E SOUTH BLVD MONTGOMERY AL 36116 (334) 288-2100 500 10024 JACKSON HOSPITAL & CLINIC INC 1725 PINE STREET MONTGOMERY AL 36106 (334) 293-8000 500 10025 GEORGE H LANIER MEMORIAL HOSPITAL 4800 48TH ST VALLEY AL 36854 (334) 756-1401 80 10027 ELBA GENERAL HOSPITAL 987 DRAYTON STREET ELBA AL 36323 (334) 897-2257 150 10029 EAST ALABAMA MEDICAL CENTER AND SNF 2000 PEPPERELL PARKWAY OPELIKA AL 36801 (334) 705-1300 400 10032 WEDOWEE HOSPITAL 209 NORTH MAIN STREET WEDOWEE AL 36278 (256) 357-2111 550 10033 UNIVERSITY OF ALABAMA HOSPITAL 619 SOUTH 19TH STREET BIRMINGHAM AL 35233 (205) 934-4011 360 10034 COMMUNITY HOSPITAL INC 805 FRIENDSHIP ROAD TALLASSEE AL 36078 (334) 283-6541 250 10035 CULLMAN REGIONAL MEDICAL CENTER 1912 ALABAMA HIGHWAY 157 CULLMAN AL 35058 (256) 737-2000 210 10036 ANDALUSIA REGIONAL HOSPITAL 849 SOUTH THREE NOTCH STREET ANDALUSIA AL 36420 (334) 222-8466 190 10038 STRINGFELLOW MEMORIAL HOSPITAL 301 EAST 18TH ST ANNISTON AL 36201 (256) 235-8900 70 10039 HUNTSVILLE HOSPITAL 101 SIVLEY RD HUNTSVILLE AL 35801 (256) 517-8120 440 10040 GADSDEN REGIONAL MEDICAL CENTER 1007 GOODYEAR AVENUE GADSDEN AL 35903 (256) 494-4000 270 10043 CHILTON MEDICAL CENTER 1010 LAY DAM ROAD CLANTON AL 35045 (205) 755-2500 100 10044 MARION REGIONAL MEDICAL CENTER 1256 MILITARY STREET SOUTH HAMILTON AL 35570 (205) 921-6200 460 10045 FAYETTE MED CTR AND LONG TERM CARE UNI 1653 TEMPLE AVENUE NORTH FAYETTE AL 35555 (205) 932-5966 280 10046 RIVERVIEW REGIONAL MEDICAL CENTER 600 SOUTH THIRD STREET GADSDEN AL 35901 (256) 543-5200 270 10047 GEORGIANA HOSP 515 MIRANDA ST GEORGIANA AL 36033 (334) 376-2205 60 10049 MEDICAL CENTER ENTERPRISE 400 N EDWARDS STREET ENTERPRISE AL 36330 (334) 347-0584 150 10050 MEDICAL CENTER BLOUNT 150 GILBREATH DRIVE ONEONTA AL 35121 (205) 625-3511 40 10051 GREENE COUNTY HOSPITAL AND NURSING HOM 509 WILSON AVENUE EUTAW AL 35462 (205) 372-3388 310 10052 LAKEMARTIN COMMUNITY HOSPITAL 201 MARIARDEN ROAD DADEVILLE AL 36853 (205) 825-7821 610 10053 ATMORE COMMUNITY HOSPITAL 401 MEDICAL PARK DR, MED PARK PLAZA ATMORE AL 36502 (251) 368-2500 260 10054 PARKWAY MEDICAL CENTER HOSPITAL 1874 BELTLINE RD SW DECATUR AL 35601 (256) 350-2211 510 10055 FLOWERS HOSPITAL 4370 WEST MAIN STREET DOTHAN AL 36305 (334) 793-5000 340 10056 ST VINCENTS HOSPITAL 810 ST VINCENTS DRIVE BIRMINGHAM AL 35205 (205) 939-7000 360 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 2 Provider ID Hospital Name Address City State ZIP Telephone County 10058 BIBB MEDICAL CENTER HOSPITAL 164 PIERSON AVENUE CENTREVILLE AL 35042 (205) 926-4881 30 10059 BAPTIST LAWRENCE 202 HOSPITAL STREET MOULTON AL 35650 (205) 974-2200 390 10061 JACKSON CO HOSP & NURSING HOME 380 WOODS COVE ROAD SCOTTSBORO AL 35768 (256) 259-4444 350 10062 WIREGRASS MEDICAL CENTER 1200 W MAPLE AVENUE GENEVA AL 36340 (334) 684-3655 300 10064 CARRAWAY METHODIST MEDICAL CENTER 1600 CARRAWAY BOULEVARD BIRMINGHAM AL 35234 (205) 502-6000 360 10065 RUSSELL HOSPITAL 3316 HIGHWAY 280 ALEXANDER CITY AL 35010 (256) 329-7100 610 10066 FLORALA MEMORIAL HOSPITAL 515 EAST FIFTH AVENUE FLORALA AL 36442 (334) 858-3287 190 10068 HEALTHSOUTH METRO WEST HOSPITAL 701 RICHARD M SCRUSHY PARKWAY FAIRFIELD AL 35064 (205) 877-1000 360 10069 LAKEVIEW COMMUNITY HOSPITAL 820 W WASHINGTON ST EUFAULA AL 36027 (334) 687-5761 20 10072 COOSA VALLEY BAPTIST MEDICAL CENTER 315 W HICKORY ST SYLACAUGA AL 35150 (256) 249-5600 600 10073 CLAY COUNTY HOSPITAL 83825 HIGHWAY 9 ASHLAND AL 36251 (205) 354-2131 130 10078 NORTHEAST ALABAMA REGIONAL MED CENTER 400 EAST 10TH STREET ANNISTON AL 36207 (256) 235-5255 70 10079 ATHENS-LIMESTONE HOSPITAL 700 WEST MARKET STREET ATHENS AL 35611 (256) 233-9292 410 10083 SOUTH BALDWIN REGIONAL MEDICAL CENTER 1613 NORTH MCKENZIE STREET FOLEY AL 36535 (251) 952-3454 10 10084 HEALTHSOUTH MEDICAL CENTER 1201 ELEVENTH AVENUE SOUTH BIRMINGHAM AL 35205 (205) 930-7100 360 10085 DECATUR GENERAL HOSPITAL 1201 7TH STREET SE DECATUR AL 35609 (256) 341-2000 510 10086 CARRAWAY NORTHWEST MEDICAL CENTER 1530 U S HIGHWAY 43 WINFIELD AL 35594 (205) 487-7000 460 10087 UNIV OF SOUTH ALABAMA MEDICAL CENTER 2451 FILLINGIM STREET MOBILE AL 36617 (334) 471-7110 480 10089 WALKER BAPTIST MEDICAL CENTER 3400 HIGHWAY 78 EAST JASPER AL 35501 (205) 387-4000 630 10090 PROVIDENCE HOSPITAL 6801 AIRPORT BOULEVARD MOBILE AL 36608 (334) 633-1000 480 10091 GROVE HILL MEMORIAL HOSPITAL 295 SOUTH JACKSON GROVE HILL AL 36451 (334) 275-3191 120 10092 D C H REGIONAL MEDICAL CENTER 809 UNIVERSITY BOULEVARD EAST TUSCALOOSA AL 35401 (205) 759-7147 620 10095 HALE COUNTY HOSPITAL FIRST & GREEN STREETS GREENSBORO AL 36744 (334) 624-3024 320 10097 ELMORE COMMUNITY HOSPITAL 500 HOSPITAL DRIVE WETUMPKA AL 36092 (334) 567-4311 250 10098 RANDOLPH MEDICAL CENTER 59928 HIGHWAY 22 ROANOKE AL 36274 (334) 863-4111 550 10099 D W MCMILLAN MEMORIAL HOSPITAL 1301 BELLEVILLE AVENUE BREWTON AL 36426 (334) 867-8061 260 10100 THOMAS HOSPITAL 750 MORPHY AVENUE FAIRHOPE AL 36532 (334) 928-2375 10 10101 CITIZENS BAPTIST MEDICAL CENTER 604 STONE AVENUE TALLADEGA AL 35161 (256) 761-4542 600 10102 J PAUL JONES HOSPITAL 317 MCWILLIAMS AVENUE CAMDEN AL 36726 (334) 682-4131 650 10103 BAPTIST MEDICAL CENTER PRINCETON 701 PRINCETON AVENUE SOUTHWEST BIRMINGHAM AL 35211 (205) 783-3000 360 10104 BIRMINGHAM BAPT MED CNTR MONTCLAIR SNU 800 MONTCLAIR RD BIRMINGHAM AL 35213 (205) 592-1000 360 10108 PRATTVILLE BAPTIST HOSPITAL 124 S MEMORIAL DR PRATTVILLE AL 36067 (334) 365-0651 0 10109 PICKENS COUNTY MEDICAL CENTER INC 241 ROBERT K WILSON CARROLLTON AL 35447 (205) 367-8111 530 10110 BULLOCK COUNTY HOSPITAL 102 WEST CONECUH AVENUE UNION SPRINGS AL 36089 (334) 738-2140 50 10112 BRYAN W WHITFIELD MEM HOSP INC 105 HIGHWAY 80 EAST DEMOPOLIS AL 36732 (334) 289-4000 450 10113 MOBILE INFIRMARY 5 MOBILE INFIRMARY CIRCLE MOBILE AL 36652 (251) 435-4700 480 10114 UAB MEDICAL WEST 995 9TH AVENUE SOUTHWEST BESSEMER AL 35021 (205) 481-7000 360 10115 RED BAY HOSPITAL 211 HOSPITAL ROAD RED BAY AL 35582 (205) 356-9532 290 10118 VAUGHN REG MED CENTER PARKWAY CAMPUS 1015 MEDICAL CENTER PARKWAY SELMA AL 36701 (334) 418-4190 230 10119 UNIV OF SOUTH AL CHILDRENS AND WOMENS 1700 CENTER STREET MOBILE AL 36604 (334) 415-1000 480 10120 MONROE COUNTY HOSPITAL 2016 SOUTH ALABAMA AVENUE MONROEVILLE AL 36461 (334) 575-3111 490 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 3 Provider ID Hospital Name Address City State ZIP Telephone County 10125 CARRAWAY BURDICK WEST MEDICAL CENTER HIGHWAY 195 EAST HALEYVILLE AL 35565 (205) 486-5213 660 10126 EDGE REGIONAL MEDICAL CENTER 1330 HIGHWAY 231 SOUTH TROY AL 36081 (334) 670-5411 540 10128 JACKSON MEDICAL CENTER 220 HOSPITAL DRIVE JACKSON AL 36545 (334) 246-9021 120 10129 NORTH BALDWIN INFIRMARY 1815 HAND AVENUE BAY MINETTE AL 36507 (334) 937-2180 10 10130 ST CLAIR REGIONAL HOSPITAL 2805 DR JOHN HAYNES DRIVE PELL CITY AL 35125 (205) 338-3301 570 10131 CRESTWOOD HOSPITAL 1 HOSPITAL DR HUNTSVILLE AL 35801 (256) 882-3100 440 10134 WASHINGTON COUNTY INFIRMARY ST STEPHENS AVENUE CHATOM AL 36518 (251) 847-2223 640 10137 COOPER GREEN HOSPITAL 1515 6TH AVENUE SOUTH BIRMINGHAM AL 35233 (205) 930-3600 360 10138 HILL HOSPITAL OF SUMTER COUNTY 751 DERBY DRIVE YORK AL 36925 (205) 392-5263 590 10139 BROOKWOOD MEDICAL CENTER 2010 BROOKWOOD MEDICAL CENTER DRIVEBIRMINGHAM AL 35209 (205) 877-1000 360 10143 WOODLAND MEDICAL CENTER 1910 CHEROKEE AVENUE SW CULLMAN AL 35055 (256) 739-3500 210 10144 SPRINGHILL MEMORIAL HOSPITAL 3719 DAUPHIN STREET MOBILE AL 36608 (334) 344-9630 480 10145 NORTHPORT MEDICAL CENTER 2700 HOSPITAL DRIVE NORTHPORT AL 35476 (205) 333-4500 620 10146 JACKSONVILLE HOSPITAL 1701 SOUTH PELHAM ROAD JACKSONVILLE AL 36265 (256) 435-4970 70 10148 EVERGREEN MEDICAL CENTER 101 CRESTVIEW AVENUE EVERGREEN AL 36401 (334) 578-2480 170 10149 BAPTIST MEDICAL CENTER EAST 400 TAYLOR ROAD MONTGOMERY AL 36117 (334) 277-8330 500 10150 L V STABLER MEMORIAL HOSPITAL 29 L V STABLER DRIVE GREENVILLE AL 36037 (334) 382-2671 60 10152 UNIV OF SOUTH AL KNOLLWOOD PK LTC HOSP 5600 GIRBY RD MOBILE AL 36693 (334) 660-5236 480 10157 SHOALS HOSPITAL 201 WEST AVALON AVENUE MUSCLE SHOALS AL 35661 (256) 386-1601 160 10158 RUSSELLVILLE HOSPITAL 15155 HIGHWAY 43 RUSSELLVILLE AL 35653 (256) 332-1611 290 12006 USA KNOLLWOOD PARK LTC HOSPITAL 5644 GIRBY ROAD BOX 9753 MOBILE AL 36693 (334) 660-5633 480 12007 LONG TERM CARE HOSP OF JACKSON, THE 1725 PINE STREET 5TH FLOOR NORTH WINGMONTGOMERY AL 36106 (334) 240-0532 500 12008 SELECT SPECIALTY HOSP-BIRMINGHAM 800 MONTCLAIR ROAD BIRMINGHAM AL 35213 (205) 599-4606 360 13025 HEALTHSOUTH LAKESHORE REHAB HOSPITAL 3800 RIDGEWAY DRIVE BIRMINGHAM AL 35209 (205) 868-2000 360 13027 MERCY MEDICAL A CORPORATION 101 VILLA DRIVE DAPHNE AL 36526 (251) 626-2694 10 13028 HEALTH SOUTH REHAB HOSP OF MONTGOMERY 4465 NARROW LANE RD MONTGOMERY AL 36116 (334) 284-7700 500 13029 HEALTHSOUTH REHAB HOSP OF NORTH ALA 107 GOVERNORS DRIVE HUNTSVILLE AL 35801 (256) 535-2300 440 13030 HEALTHSOUTH REHABILITATION HOSPITAL 1736 EAST MAIN STREET DOTHAN AL 36301 (334) 712-6333 340 13032 HEALTHSOUTH REHABILITATION HOSPITAL 801 GOODYEAR AVENUE GADSDEN AL 35903 (256) 439-5000 270 13300 CHILDRENS HOSPITAL OF ALABAMA 1600 SEVENTH AVENUE SOUTH BIRMINGHAM AL 35233 (205) 939-9100 360 14000 HILL CREST BEHAVIORAL HEALTH SERVICES 6869 FIFTH AVENUE SOUTH BIRMINGHAM AL 35212 (205) 833-9000 360 14005 GREIL MEMORIAL PSYCHIATRIC HOSP 2140 UPPER WETUMPKA RD MONTGOMERY AL 36107 (334) 262-0363 500 14006 MOUNTAIN VIEW HOSPITAL 3201 SCENIC HIGHWAY GADSDEN AL 35902 (256) 546-9265 270 14007 BRYCE HOSPITAL 200 UNIVERSITY BLVD TUSCALOOSA AL 35401 (205) 759-0750 620 14008 SEARCY HOSPITAL ACUTE CARE ADMISS UNIT 725 EAST COY SMITH HIGHWAY MT VERNON AL 36560 (251) 829-9411 10 14009 NORTH ALABAMA REGIONAL HOSPITAL 4218 HWY 31 OUTH DECATUR AL 35609 (256) 353-9433 510 14011 TAYLOR HARDIN SECURE MEDICAL FACILITY 1301 RIVER ROAD NORTHEAST TUSCALOOSA AL 35404 (205) 556-7060 620 14012 MARY S HARPER GERIATRIC PSYCHIATRY CTR 201 UNIVERSITY BLVD TUSCALOOSA AL 35402 (205) 759-0900 620 14013 RAMSAY YOUTH SERVICES DOTHAN 700 EAST COTTONWOOD RD DOTHAN AL 36301 (334) 794-7373 340 20001 PROVIDENCE ALASKA MEDICAL CENTER 3200 PROVIDENCE DRIVE,BOX 196604 ANCHORAGE AK 99519 (907) 261-3675 20 20004 KETCHIKAN GENERAL HOSPITAL 3100 TONGASS AVE KETCHIKAN AK 99901 (907) 225-5171 130 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 4 Provider ID Hospital Name Address City State ZIP Telephone County 20005 NORTON SOUND REGIONAL HOSPITAL PO BOX 966, 5TH AND BERING NOME AK 99762 (907) 443-3311 180 20006 VALLEY HOSPITAL 515 E DAHLIA,PO BOX 1687 PALMER AK 99645 (907) 746-8600 170 20008 BARTLETT REGIONAL HOSPITAL 3260 HOSPITAL DR JUNEAU AK 99801 (907) 586-8447 110 20010 CORDOVA COMMUNITY MEDICAL CENTER 602 CHASE AVE, BOX 160 CORDOVA AK 99574 (907) 424-8000 20 20012 FAIRBANKS MEMORIAL HOSPITAL 1650 COWLES STREET FAIRBANKS AK 99701 (907) 452-8181 90 20013 PROVIDENCE KODIAK ISLAND MEDICAL CENTE 1915 EAST REZANOF DR KODIAK AK 99615 (907) 486-3281 150 20014 SOUTH PENINSULA HOSPITAL 4300 BARTLETT ST HOMER AK 99603 (907) 235-8101 20 20017 COLUMBIA ALASKA REGIONAL HOSPITAL 2801 DEBARR ROAD ANCHORAGE AK 99508 (907) 276-1131 20 20018 YUKON KUSKOKWIM DELTA REG HOSPITAL PO BOX 287,STE 3000 BETHEL AK 99559 (907) 543-6300 50 20019 SAMUEL SIMMONDS MEMORIAL HOSPITAL 1296 AGVIK ST, BOX 29 BARROW AK 99723 (907) 852-4611 20 20020 MANILAQ HEALTH CENTER 5TH & GRIZZLEY WAY, BOX 43 KOTZEBUE AK 99752 (907) 442-3321 20 20021 BRISTOL BAY AREA HEALTH CORP 6000 KANAKANAK RD, BOX 130 DILLINGHAM AK 99576 (907) 842-5201 70 20024 CENTRAL PENINSULA GENERAL HOSPITAL 250 HOSPITAL PLACE SOLDOTNA AK 99669 (907) 262-4404 120 20026 ALASKA NATIVE MEDICAL CENTER, PHS 4315 DIPLOMACY DR ANCHORAGE AK 99508 (907) 563-2662 20 20027 MT EDGECUMBE HOSPITAL 222 TONGASS DR SITKA AK 99835 (907) 966-2411 220 21301 VALDEZ COMMUNITY HOSPITAL P O BOX 550, 911 MEALS AVENUE VALDEZ AK 99686 (907) 835-2249 260 21302 PROVIDENCE SEWARD MEDICAL CENTER 417 FIRST AVENUE, PO BOX 365 SEWARD AK 99664 (907) 224-5205 270 21303 SITKA COMMUNITY HOSPITAL 209 MOLLER DRIVE SITKA AK 99835 (907) 747-3241 220 21304 PETERSBURG MEDICAL CENTER 103 FRAM STREET, PO BOX 589 PETERSBURG AK 99833 (907) 772-4291 280 21305 WRANGELL MEDICAL CENTER 310 BENNETT STREET PO BOX 1081 WRANGELL AK 99929 (907) 874-7000 280 24001 NORTH STAR HOSPITAL 2530 DEBARR RD ANCHORAGE AK 99508 (907) 264-3526 20 24002 ALASKA PSYCHIATRIC INSTITUTE 2900 PROVIDENCE DRIVE ANCHORAGE AK 99508 (907) 269-7100 20 30001 MARYVALE HOSPITAL MEDICAL CENTER 5102 WEST CAMPBELL AVENUE PHOENIX AZ 85031 (623) 848-5100 60 30002 GOOD SAMARITAN REGIONAL MEDICAL CENTER 1111 EAST MCDOWELL RD PHOENIX AZ 85006 (602) 239-2000 60 30004 SAGE MEMORIAL HOSPITAL GANADO MISSION PO BOX 457 GANADO AZ 86505 (928) 755-4500 0 30006 TUCSON MEDICAL CENTER 5301 EAST GRANT RD TUCSON AZ 85733 (520) 323-5461 90 30007 VERDE VALLEY MEDICAL CENTER 269 SOUTH CANDY LANE COTTONWOOD AZ 86326 (925) 634-2251 120 30009 KINO COMMUNITY HOSPITAL 2800 EAST AJO WAY TUCSON AZ 85713 (520) 294-4471 90 30010 CARONDELET ST MARYS HOSPITAL 1601 WEST ST MARY'S ROAD TUCSON AZ 85745 (520) 622-5833 90 30011 CARONDELET SAINT JOSEPHS HOSPITAL 350 NORTH WILMOT RD TUCSON AZ 85711 (520) 296-3211 90 30012 YAVAPAI REGIONAL MEDICAL CENTER 1003 WILLOW CREEK ROAD PRESCOTT AZ 86301 (925) 445-2700 120 30013 YUMA REGIONAL MEDICAL CENTER 2400 AVENUE A YUMA AZ 85364 (928) 344-7044 130 30014 JOHN C LINCOLN HOSP NORTH MOUNTAIN 250 EAST DUNLAP PHOENIX AZ 85020 (602) 943-2381 60 30016 CASA GRANDE REGIONAL MEDICAL CENTER 1800 EAST FLORENCE BOULEVARD CASA GRANDE AZ 85222 (520) 426-6300 100 30017 MESA GENERAL HOSPITAL MEDICAL CENTER 515 NORTH MESA DRIVE MESA AZ 85201 (480) 969-9111 60 30018 MESA LUTHERAN HOSPITAL 525 WEST BROWN ROAD MESA AZ 85201 (480) 834-1211 60 30019 TEMPE ST LUKE'S HOSPITAL 1500 SOUTH MILL AVENUE TEMPE AZ 85281 (408) 968-9411 60 30022 MARICOPA MEDICAL CENTER 2601 EAST ROOSEVELT STREET PHOENIX AZ 85008 (602) 267-5011 60 30023 FLAGSTAFF MEDICAL CENTER 1200 NORTH BEAVER STREET FLAGSTAFF AZ 86001 (602) 779-3366 20 30024 ST JOSEPH'S HOSPITAL MEDICAL CENTER 350 WEST THOMAS ROAD PHOENIX AZ 85013 (602) 406-3000 60 30027 COPPER QUEEN COMMUNITY HOSPITAL 101 COLE AVENUE BISBEE AZ 85603 (520) 432-5383 10 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 5 Provider ID Hospital Name Address City State ZIP Telephone County 30030 PHOENIX BAPTIST HOSP & MED CENTER 6025 NORTH 20TH AVENUE PHOENIX AZ 85015 (602) 246-5747 60 30033 PAYSON REGIONAL MEDICAL CENTER 807 SOUTH PONDEROSA PAYSON AZ 85541 (925) 474-3222 30 30036 CHANDLER REGIONAL HOSPITAL 475 SOUTH DOBSON ROAD CHANDLER AZ 85224 (480) 963-4561 60 30037 ST LUKE'S MEDICAL CENTER 1800 EAST VAN BUREN PHOENIX AZ 85006 (602) 251-8100 60 30038 SCOTTSDALE HEALTHCARE-OSBORN 7400 EAST OSBORN ROAD SCOTTSDALE AZ 85251 (408) 675-4000 60 30040 CARONDELET HOLY CROSS HOSPITAL INC 1171 WEST TARGET RANGE ROAD NOGALES AZ 85621 (520) 287-2771 110 30043 SIERRA VISTA REGIONAL HEALTH CENTER 300 EL CAMINO REAL SIERRA VISTA AZ 85635 (520) 458-4641 10 30044 WINSLOW MEMORIAL HOSPITAL 1501 WILLIAMSON AVE WINSLOW AZ 86047 (928) 289-4691 80 30048 MORENCI HOSPITAL CORONADO BLVD BURRO ALLEY MORENCI AZ 85540 (928) 865-4511 50 30055 KINGMAN REGIONAL MEDICAL CENTER 3269 STOCKTON HILL RD KINGMAN AZ 86401 (928) 757-2101 70 30060 COBRE VALLEY COMMUNITY HOSPITAL 5880 S HOSPITAL DR GLOBE AZ 85501 (928) 425-3261 30 30061 WALTER O BOSWELL MEMORIAL HOSPITAL 10401 THUNDERBIRD BLVD SUN CITY AZ 85351 (602) 977-7211 60 30062 NAVAPACHE HOSPITAL 2200 SHOW LOW LAKE ROAD SHOW LOW AZ 85901 (928) 537-4375 80 30064 UNIVERSITY MEDICAL CENTER 1501 N CAMPBELL AVE TUCSON AZ 85724 (520) 694-6501 90 30065 DESERT SAMARITAN MEDICAL CENTER 1400 SOUTH DOBSON ROAD MESA AZ 85202 (408) 835-3000 60 30067 LA PAZ REGIONAL HOSPITAL 1200 MOHAVE ROAD P O BOX 1149 PARKER AZ 85344 (928) 669-9201 0 30068 MT GRAHAM REGIONAL MEDICAL CENTER 1600 20TH AVE SAFFORD AZ 85546 (928) 508-2845 40 30069 HAVASU REGIONAL MEDICAL CENTER 101 CIVIC CENTER LANE LAKE HAVASU CITY AZ 86403 (928) 855-8185 70 30071 PHS INDIAN HOSPITAL P O BOX 649 FORT DEFIANCE AZ 86504 (602) 729-5741 0 30072 PHS INDIAN HOSPITAL P O BOX 98 KEAMS CANYON AZ 86034 (602) 738-2211 80 30073 PHS INDIAN HOSPITAL TUBA CITY AZ 86045 (602) 283-6211 20 30074 PHS INDIAN HOSPITAL P O BOX 548 SELLS AZ 85634 (520) 383-7200 90 30076 HU HU KAM MEMORIAL HOSPITAL PO BOX 38 SACATON AZ 85247 (602) 562-3326 60 30077 PHS INDIAN HOSPITAL SAN CARLOS AZ 85550 (602) 475-2381 30 30078 PHS INDIAN MEDICAL CENTER 4212 N 16TH STREET PHOENIX AZ 85016 (602) 263-1200 60 30079 PARKER PHS INDIAN HOSPITAL RT 1 BOX 12 PARKER AZ 85344 (602) 669-2137 30080 EL DORADO HOSPITAL 1400 NORTH WILMOT ROAD, PO BOX 13070 TUCSON AZ 85712 (520) 886-6361 90 30083 PARADISE VALLEY HOSPITAL 3929 EAST BELL RD PHOENIX AZ 85032 (602) 923-5100 60 30084 CHINLE COMPREHENSIVE CARE FACILITY P O BOX PH CHINLE AZ 86503 (602) 674-5281 0 30085 NORTHWEST MEDICAL CENTER 6200 N LA CHOLLA BLVD TUCSON AZ 85741 (520) 742-9000 90 30087 SCOTTSDALE HEALTHCARE-SHEA 9003 EAST SHEA BOULEVARD SCOTTSDALE AZ 85261 (480) 860-3000 60 30088 VALLEY LUTHERAN HOSPITAL 6644 BAYWOOD AVE MESA AZ 85206 (480) 981-2000 60 30089 THUNDERBIRD SAMARITAN HOSP & HLTH CTR 5555 WEST THUNDERBIRD ROAD GLENDALE AZ 85306 (602) 588-5555 60 30092 JOHN C LINCOLN HOSPITAL-DEER VALLEY 19829 NORTH 27TH AVE PHOENIX AZ 85027 (623) 879-6100 60 30093 DEL E WEBB MEMORIAL HOSPITAL 14502 WEST MEEKER BLVD SUN CITY WEST AZ 85375 (623) 214-4000 60 30094 ARROWHEAD COMMUNITY HOSP/MED CENTER 18701 NORTH 67TH AVE GLENDALE AZ 85312 (623) 561-1000 60 30099 WHITE MOUNTAIN COMMUNTIES HOSPITAL 118 SOUTH MOUNTAIN AVE SPRINGERVILLE AZ 85938 (928) 333-4368 0 30100 TUCSON HEART HOSPITAL 4888 NORTH STONE AVENUE TUCSON AZ 85704 (520) 696-2345 90 30101 WESTERN ARIZONA REGIONAL MEDICAL CTR 2735 SILVER CREEK ROAD BULLHEAD CITY AZ 86442 (928) 673-0239 70 30102 ARIZONA HEART HOSPITAL 1930 EAST THOMAS ROAD PHOENIX AZ 85016 (602) 532-1000 60 30103 MAYO CLINIC HOSPITAL 5777 EAST MAYO BLVD PHOENIX AZ 85054 (480) 515-6296 60 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 6 Provider ID Hospital Name Address City State ZIP Telephone County 30105 LUTHERAN HEART HOSPITAL 6750 EAST BAYWOOD AVENUE MESA AZ 85206 (480) 854-5000 60 30106 PHOENIX MEMORIAL HOSPITAL 1201 7TH AVENUE PHOENIX AZ 85007 (602) 258-5111 60 31300 WICKENBURG REGIONAL HOSPITAL 520 ROSE LANE WICKENBURG AZ 85390 (520) 684-5421 60 31301 BENSON HOSPITAL 450 SOUTH OCOTILLO STREET BENSON AZ 85602 (520) 586-2261 10 31302 NORTHERN COCHISE COMMUNITY HOSPITAL 901 REX ALLEN DRIVE WILLCOX AZ 85643 (520) 384-3541 10 31303 SOUTHEAST ARIZONA MEDICAL CENTER 2174 W OAK ROAD DOUGLAS AZ 85607 (520) 364-7931 10 31304 PAGE HOSPITAL 501 NORTH NAVAJO DRIVE PAGE AZ 86040 (928) 645-0112 20 32000 KINDRED HOSPITAL ARIZONA PHOENIX 40 EAST INDIANOLA STREET PHOENIX AZ 85012 (602) 933-0155 60 32001 SELECT SPECIALTY HOSPITAL ARIZONA INC 350 WEST THOMAS ROAD PHOENIX AZ 85013 (602) 406-6800 60 32002 KINDRED HOSPITAL - TUCSON 355 NORTH WILMOT ROAD TUCSON AZ 85711 (520) 490-7962 90 32004 SUMMIT HOSPITAL OF SOUTHEAST AZ 7220 EAST ROSEWOOD TUCSON AZ 85710 (520) 546-4595 90 32005 SELECT SPECIALTY HOSPITAL ARIZONA INC 525 WEST BROWN ROAD MESA AZ 85201 (480) 461-2706 60 33025 HEALTHSOUTH MERIDIAN POINT REHAB HOSP 11250 NORTH 92ND STREET SCOTTSDALE AZ 85260 (602) 222-7803 60 33028 HEALTHSOUTH REHAB INSTITUTE OF TUCSON 2650 NORTH WYATT DRIVE TUCSON AZ 85712 (520) 325-1300 90 33032 HEALTHSOUTH VALLEY OF THE SUN 13460 NORTH 67TH AVENUE GLENDALE AZ 85304 (623) 878-8800 60 33301 LOS NINOS HOSPITAL 2303 EAST THOMAS PHOENIX AZ 85016 (602) 954-7311 60 33302 PHOENIX CHILDREN'S HOSPITAL 1919 EAST THOMAS ROAD PHOENIX AZ 85016 (602) 546-0400 60 34004 SAMARITAN BEHAV HEALTH CNTR SCOTTSDALE 7575 EAST EARLL DRIVE SCOTTSDALE AZ 85251 (602) 941-7509 60 34013 ST LUKES BEHAVIORAL HEALTH CENTER 1800 EAST VAN BUREN PHOENIX AZ 85006 (602) 251-8535 60 34020 SENIOR HORIZONS 7100 EAST MESCAL ST SCOTTSDALE AZ 85254 (602) 443-5138 60 34021 ARIZONA STATE HOSPITAL 2500 EAST VAN BUREN STREET PHOENIX AZ 85008 (602) 220-6000 60 34022 SONORA BEHAVIORAL HEALTH 6050 NORTH CORONA ROAD TUCSON AZ 85704 (520) 469-8700 90 34023 GUIDANCE CENTER,THE 2187 NORTH VICKEY STREET FLAGSTAFF AZ 86004 (520) 527-1899 20 40001 SILOAM SPRINGS MEMORIAL HOSPITAL 205 EAST JEFFERSON SILOAM SPRINGS AR 72761 (501) 524-4141 30 40002 JOHNSON REGIONAL MEDICAL CENTER 1100 EAST POPLAR STREET CLARKSVILLE AR 72830 (501) 754-5454 350 40003 ST ANTHONY'S HEALTHCARE CENTER 4 HOSPITAL DRIVE MORRILTON AR 72110 (501) 977-2300 140 40004 WASHINGTON REGIONAL MEDICAL CENTER AT 3215 NORTH HILLS BOULEVARD FAYETTEVILLE AR 72703 (501) 713-1000 710 40007 ST VINCENT INFIRMARY MEDICAL CENTER TWO ST VINCENT CIRCLE LITTLE ROCK AR 72205 (501) 660-3000 590 40010 ST MARY ROGERS MEMORIAL HOSPITAL 1200 WEST WALNUT STREET ROGERS AR 72756 (501) 636-0200 30 40011 JOHN ED CHAMBERS MEMORIAL HOSPITAL HIGHWAY 10 AT DETROIT STREET DANVILLE AR 72833 (479) 495-6357 740 40014 CENTRAL ARKANSAS HOSPITAL 1200 SOUTH MAIN STREET SEARCY AR 72143 (501) 278-3100 720 40015 MENA MEDICAL CENTER 311 NORTH MORROW STREET MENA AR 71953 (479) 394-6100 560 40016 UNIVERSITY HOSPITAL OF ARKANSAS THE 4301 WEST MARKHAM STREET SLOT 728 LITTLE ROCK AR 72205 (501) 686-5660 590 40017 NORTH ARKANSAS MEDICAL CENTER 620 NORTH WILLOW HARRISON AR 72601 (870) 365-2000 40 40018 CRAWFORD COUNTY MEMORIAL HOSPITAL EAST MAIN AND SOUTH 20TH STREET VAN BUREN AR 72956 (501) 474-3401 160 40019 BAPTIST MEM HOSPITAL FORREST CITY INC 1601 NEWCASTLE ROAD FORREST CITY AR 72335 (870) 261-0000 610 40020 ST BERNARDS REGIONAL MEDICAL CENTER 224 EAST JACKSON JONESBORO AR 72401 (870) 972-4100 150 40021 SOUTHWEST REGIONAL MEDICAL CENTER 11401 INTERSTATE 30 LITTLE ROCK AR 72209 (501) 455-7100 590 40022 NORTHWEST MEDICAL CENTER OF WASHINGTON 609 WEST MAPLE AVENUE SPRINGDALE AR 72764 (501) 751-5711 710 40024 ASHLEY COUNTY MEDICAL CENTER 1015 UNITY ROAD CROSSETT AR 71635 (870) 364-4111 10 40026 ST JOSEPHS MERCY HEALTH CENTER INC 300 WERNER STREET HOT SPRINGS AR 71913 (501) 622-1000 250 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 7 Provider ID Hospital Name Address City State ZIP Telephone County 40027 BAXTER REGIONAL MEDICAL CENTER 624 HOSPITAL DRIVE MOUNTAIN HOME AR 72653 (870) 508-1039 20 40028 BOONEVILLE COMMUNITY HOSPITAL 880 WEST MAIN BOONEVILLE AR 72927 (501) 675-2800 410 40029 CONWAY REGIONAL MEDICAL CENTER 2302 COLLEGE AVENUE CONWAY AR 72032 (501) 329-3831 220 40032 LITTLE RIVER MEMORIAL HOSPITAL 451 WEST LOCKE STREET ASHDOWN AR 71822 (870) 898-5011 400 40035 FULTON COUNTY HOSPITAL 679 NORTH MAIN STREET SALEM AR 72576 (870) 895-2691 240 40036 BAPTIST HEALTH MEDICAL CENTER - NLR 3333 SPRINGHILL DRIVE NORTH LITTLE ROCK AR 72114 (501) 202-3000 590 40039 ARKANSAS METHODIST HOSPITAL 900 WEST KINGSHIGHWAY PARAGOULD AR 72450 (870) 239-7000 270 40041 ST MARYS REGIONAL MEDICAL CENTER 1808 WEST MAIN STREET RUSSELLVILLE AR 72801 (501) 968-2841 570 40042 CRITTENDEN MEMORIAL HOSPITAL 200 TYLER WEST MEMPHIS AR 72301 (870) 735-1500 170 40045 PIGGOTT COMMUNITY HOSPITAL 1206 GORDON DUCKWORTH DRIVE PIGGOTT AR 72454 (870) 598-3881 100 40047 RANDOLPH COUNTY MEDICAL CENTER 2801 MEDICAL CENTER DRIVE POCAHONTAS AR 72455 (870) 892-6000 600 40050 OUACHITA COUNTY MEDICAL CENTER 638 CALIFORNIA AVENUE CAMDEN AR 71701 (870) 836-1200 510 40051 DREW MEMORIAL HOSPITAL 778 SCOGIN DRIVE MONTICELLO AR 71655 (870) 367-2411 210 40053 DELTA MEMORIAL HOSPITAL 300 EAST PICKENS DUMAS AR 71639 (870) 382-4303 200 40054 NEWPORT HOSPITAL AND CLINIC INC 2000 MCLAIN STREEET NEWPORT AR 72112 (870) 523-6721 330 40055 SPARKS REGIONAL MEDICAL CENTER 1311 SOUTH I STREET FORT SMITH AR 72901 (501) 441-4000 650 40062 ST EDWARD MERCY MEDICAL CENTER 7301 ROGERS AVE FORT SMITH AR 72917 (501) 484-6100 650 40066 BAPTIST HEALTH MEDICAL CENTER -ARKADEL 3050 TWIN RIVERS DRIVE ARKADELPHIA AR 71923 (870) 245-2622 90 40067 MAGNOLIA HOSPITAL 101 HOSPITAL DRIVE POST OFFICE BOX 629 MAGNOLIA AR 71753 (870) 235-3000 130 40069 BAPTIST MEMORIAL HOSPITAL BLYTHEVILLE 1520 NORTH DIVISION STREET BLYTHEVILLE AR 72315 (870) 838-7300 460 40070 BAPTIST MEMORIAL HOSPITAL OSCEOLA 611 WEST LEE AVENUE OSCEOLA AR 72370 (870) 563-7000 460 40071 JEFFERSON REGIONAL MEDICAL CENTER 1515 WEST 42ND AVENUE PINE BLUFF AR 71603 (870) 541-7100 340 40072 STUTTGART REGIONAL MEDICAL CENTER 1703 NORTH BUERKLE ROAD STUTTGART AR 72160 (870) 673-3511 0 40074 REBSAMEN MEDICAL CENTER INC 1400 BRADEN STREET JACKSONVILLE AR 72076 (501) 985-7000 590 40075 GRAVETTE MEDICAL CENTER HOSPITAL 1101 JACKSON STREET SW GRAVETTE AR 72736 (501) 787-5291 30 40076 HOT SPRING COUNTY MEDICAL CENTER 1001 SCHNEIDER DRIVE MALVERN AR 72104 (501) 332-7382 290 40077 BRADLEY COUNTY MEDICAL CENTER 404 SOUTH BRADLEY STREET WARREN AR 71671 (870) 226-3731 50 40078 NATIONAL PARK MEDICAL CENTER INC 1910 MALVERN AVENUE HOT SPRINGS AR 71901 (501) 321-1000 250 40080 HARRIS HOSPITAL 1205 MCLAIN STREET NEWPORT AR 72112 (870) 523-8911 330 40081 PIKE COUNTY MEMORIAL HOSPITAL 315 EAST 13TH STREET, P O BOX F MURFREESBORO AR 71958 (870) 285-3182 540 40084 SALINE MEMORIAL HOSPITAL #1 MEDICAL PARK DRIVE BENTON AR 72015 (501) 776-6010 620 40085 HELENA REGIONAL MEDICAL CENTER 1801 MARTIN LUTHER KING DRIVE HELENA AR 72342 (870) 338-5800 530 40088 MEDICAL CENTER OF SOUTH ARKANSAS 700 WEST GROVE EL DORADO AR 71731 (870) 864-3290 690 40091 MEDICAL PARK HOSPITAL 2001 SOUTH MAIN STREET HOPE AR 71801 (870) 777-2323 280 40100 WHITE COUNTY MEDICAL CENTER 3214 EAST RACE AVENUE SEARCY AR 72143 (501) 268-6121 720 40105 CHICOT MEMORIAL HOSPITAL 2729 HIGHWAY 65 AND 82 SOUTH LAKE VILLAGE AR 71653 (870) 265-5351 80 40107 DE QUEEN REGIONAL MEDICAL CENTER 1306 WEST COLLIN RAYE DRIVE DE QUEEN AR 71832 (870) 584-4111 660 40109 CARROLL REGIONAL MEDICAL CENTER 214 CARTER STREET BERRYVILLE AR 72616 (870) 423-3355 70 40114 BAPTIST HEALTH MEDICAL CENTER 9601 INTERSTATE 630, EXIT 7 LITTLE ROCK AR 72205 (501) 202-2000 590 40118 REGIONAL MEDICAL CENTER OF NEA 3024 STADIUM BOULEVARD JONESBORO AR 72401 (870) 972-7000 150 40119 WHITE RIVER MEDICAL CENTER 1710 HARRISON STREET BATESVILLE AR 72503 (870) 793-1200 310 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 8 Provider ID Hospital Name Address City State ZIP Telephone County 40126 EASTERN OZARKS REGIONAL HEALTH SYSTEM 122 HOSPITAL DRIVE CHEROKEE VILLAGE AR 72529 (870) 257-4101 670 40132 LEO N LEVI NATIONAL ARTHRITIS 300 PROSPECT AVE HOT SPRINGS AR 71901 (501) 624-1281 250 40134 ARKANSAS HEART HOSPITAL 1701 SOUTH SHACKLEFORD ROAD LITTLE ROCK AR 72211 (501) 219-7000 590 40137 ST VINCENT MEDICAL CENTER-NORTH 2215 WILDWOOD SHERWOOD AR 72120 (501) 833-7100 590 40138 BATES MEDICAL CENTER 602 NORTH WALTON BOULEVARD BENTONVILLE AR 72712 (479) 751-5711 30 40141 WILLOW CREEK WOMENS HOSPITAL 4301 GREATHOUSE SPRINGS ROAD JOHNSON AR 72741 (501) 684-3000 710 40142 HOT SPRINGS SURGICAL HOSPITAL 1636 HIGDON FERRY ROAD HOT SPRINGS AR 71913 (501) 520-2000 250 41300 NORTH LOGAN MERCY HOSPITAL 500 EAST ACADEMY PARIS AR 72855 (479) 963-6101 410 41302 DARDANELLE HOSPITAL 200 NORTH THIRD STREET DARDANELLE AR 72834 (501) 229-4677 740 41303 MERCY HOSPITAL TURNER MEMORIAL 801 WEST RIVER STREET OZARK AR 72949 (501) 667-4138 230 41304 EUREKA SPRINGS HOSPITAL 24 NORRIS STREET EUREKA SPRINGS AR 72632 (501) 253-7400 70 41305 MERCY HOSPITAL OF SCOTT COUNTY HIGHWAY 80 & 71 BYPASS WALDRON AR 72958 (501) 637-4135 630 41306 COMMUNITY MEDICAL CENTER OF IZARD CO 103 GRASSE STREET CALICO ROCK AR 72519 (870) 297-3726 320 41307 CROSSRIDGE COMMUNITY HOSPITAL 310 SOUTH FALLS BOULEVARD WYNNE AR 72396 (870) 238-3300 180 41308 MCGEHEE-DESHA COUNTY HOSPITAL 900 SOUTH THIRD STREET MCGEHEE AR 71654 (870) 222-5600 200 41309 LAWRENCE MEMORIAL HOSPITAL 1309 WEST MAIN WALNUT RIDGE AR 72476 (870) 886-1266 370 41310 STONE COUNTY MEDICAL CENTER HIGHWAY 14 EAST MOUNTAIN VIEW AR 72560 (870) 269-4361 680 41311 HOWARD MEMORIAL HOSPITAL 800 WEST LESLIE NASHVILLE AR 71852 (870) 845-4400 300 41312 BAPTIST HEALTH MED CEN HEBER SPRINGS 2319 HIGHWAY 110 WEST HEBER SPRINGS AR 72543 (501) 206-3000 110 41313 OZARK HEALTH, INC HIGHWAY 65 SOUTH CLINTON AR 72031 (501) 745-7000 700 41314 DEWITT HOSPITAL & NURSING HOME INC 1641 WHITEHEAD DRIVE DEWITT AR 72042 (870) 946-3571 0 41315 BOONEVILLE COMMUNITY HOSPITAL 880 WEST MAIN BOONEVILLE AR 72927 (479) 675-2800 410 41317 DALLAS COUNTY MEDICAL CENTER 201 CLIFTON STREET FORDYCE AR 71742 (870) 352-6300 190 42000 SELECT SPECIALTY HOSPITAL 2 ST VINCENT CIRCLE, SIXTH FLOOR LITTLE ROCK AR 72204 (501) 661-1418 590 42004 ADVANCE CARE HOSPITAL 300 WERNER STREET, THIRD FLOOR HOT SPRINGS AR 71913 (501) 609-4300 250 42005 SEMPERCARE HOSPITAL OF LITTLE ROCK 9601 INTERSTATE 630 EXIT 7 LITTLE ROCK AR 72205 (501) 202-1090 590 42006 SELECT SPECIALITY HOSPITAL-FORT SMITH 1131 SOUTH I STREET FORT SMITH AR 72917 (501) 441-3960 650 43026 BAPTIST HEALTH REHABILITATION INSTITUT 9601 INTERSTATE 630 EXIT 7 LITTLE ROCK AR 72205 (501) 223-7578 590 43027 HOT SPRINGS REHABILITATION CENTER 105 RESERVE AVENUE HOT SPRINGS AR 71902 (501) 624-4411 250 43028 HEALTHSOUTH REHAB HOSP OF FORT SMITH 1401 SOUTH J STREET FORT SMITH AR 72901 (501) 785-3300 650 43029 HEALTHSOUTH REHAB HOSP OF JONESBORO 1201 FLEMING AVENUE JONESBORO AR 72401 (870) 932-0440 150 43031 ST VINCENT REHAB HOSP IN PART HLTHSOUT 2201 WILDWOOD AVE SHERWOOD AR 72120 (501) 834-1800 590 43032 HEALTHSOUTH REHAB HOSP IN PART WITH RE 153 EAST MONTE PAINTER DRIVE FAYETTEVILLE AR 72703 (501) 444-2200 710 43300 ARKANSAS CHILDREN'S HOSPITAL 800 MARSHALL STREET LITTLE ROCK AR 72202 (501) 320-1100 590 44004 VISTA HEALTH 4253 CROSSOVER ROAD FAYETTEVILLE AR 72703 (501) 521-5731 710 44005 BRIDGEWAY INC,THE 21 BRIDGEWAY ROAD NORTH LITTLE ROCK AR 72113 (501) 771-1500 590 44006 HARBOR VIEW MERCY HOSPITAL 10301 MAYO RD P O BOX 17000 FORT SMITH AR 72917 (501) 484-5550 650 44007 C C S LITTLE ROCK INC 100 RIVENDELL DRIVE BENTON AR 72015 (501) 316-1255 620 44010 ST BERNARDS BEHAVIORAL HEALTH 2712 EAST JOHNSON AVE JONESBORO AR 72401 (870) 932-2800 150 44011 ARKANSAS STATE HOSP PSYCHIATRIC DIV 4313 WEST MARKHAM STREET LITTLE ROCK AR 72205 (501) 686-9000 590 44013 PINNACLE POINTE HOSPITAL 11501 FINANCIAL CENTRE PARKWAY LITTLE ROCK AR 72211 (501) 223-3322 590 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 9 Provider ID Hospital Name Address City State ZIP Telephone County 44015 FAYETTEVILLE CITY HOSP & GERATRIC CTR 221 SOUTH SCHOOL STREET FAYETTEVILLE AR 72701 (501) 442-5100 710 44016 LIVING HOPE TEXARKANA 801 ARKANSAS BLVD TEXARKANA AR 71854 (870) 774-4673 450 44017 METHODIST BEHAVIORAL HOSPITAL 1601 MURPHY DRIVE MAUMELLE AR 72113 (501) 803-3388 590 50002 ST ROSE HOSPITAL 27200 CALAROGA AVE HAYWARD CA 94545 (510) 782-6200 0 50006 ST JOSEPH HOSPITAL 2700 DOLBEER ST EUREKA CA 95501 (707) 443-8051 110 50007 MILLS-PENINSULA HOSPITAL 1783 EL CAMINO REAL BURLINGAME CA 94010 (650) 696-5270 510 50008 DAVIES MEDICAL CENTER CASTRO DUBOCE STS SAN FRANCISCO CA 94114 (415) 600-6000 480 50009 QUEEN OF THE VALLEY 1000 TRANCAS ST NAPA CA 94558 (707) 252-4411 380 50013 ST HELENA HOSPITAL SANITARIUM & WOODLAND STS DEER PARK CA 94576 (707) 967-5899 380 50014 SUTTER AMADOR HOSPITAL 200 MISSION BLVD JACKSON CA 95642 (209) 223-7500 20 50015 NORTHERN INYO HOSPITAL 150 PIONEER LANE BISHOP CA 93514 (760) 873-5811 130 50016 ARROYO GRANDE COMMUNITY HOSPITAL 345 S HALCYON RD ARROYO GRANDE CA 93420 (805) 489-4261 500 50017 MERCY GENERAL HOSPITAL 4001 J ST SACRAMENTO CA 95819 (916) 453-4445 440 50018 PACIFIC ALLIANCE MEDICAL CENTER 531 W COLLEGE ST LOS ANGELES CA 90012 (213) 624-8411 200 50022 RIVERSIDE COMMUNITY HOSPITAL 4445 MAGNOLIA AVE RIVERSIDE CA 92501 (909) 788-3000 430 50024 PARADISE VALLEY HOSPITAL 2400 EAST FOURTH STREET NATIONAL CITY CA 91950 (619) 470-4321 470 50025 UNIV OF CALIFORNIA SAN DIEGO MED CTR 200 WEST ARBOR DRIVE SAN DIEGO CA 92103 (619) 543-6737 470 50026 GROSSMONT HOSPITAL 5555 GROSSMONT CENTER DRIVE BOX 58 LA MESA CA 91942 (619) 465-0711 470 50028 MAD RIVER COMMUNITY HOSPITAL 3800 JAMES RD ARCATA CA 95521 (707) 822-3621 110 50030 OROVILLE HOSPITAL 2767 OLIVE HWY OROVILLE CA 95965 (530) 533-8500 30 50036 BAKERSFIELD MEMORIAL HOSPITAL 420 34TH ST BOX 1888 BAKERSFIELD CA 93301 (661) 327-4647 140 50038 SANTA CLARA VALLEY MEDICAL CENTER 751 S BASCOM AVE SAN JOSE CA 95128 (408) 885-5000 530 50039 ENLOE MEDICAL CENTER 1531 ESPLANADE CHICO CA 95926 (530) 332-7371 30 50040 LA COUNTY OLIVE VIEW-UCLA MEDICAL CNTR 14445 OLIVE VIEW DRIVE SYLMAR CA 91342 (818) 364-1555 400 50042 ST ELIZABETH COMMUNITY HOSPITAL 2550 SISTER MARY COLUMBA DRIVE RED BLUFF CA 96080 (530) 529-8012 620 50043 SUMMIT MEDICAL CENTER HAWTHORNE & WEBSTER STS OAKLAND CA 94609 (510) 655-4000 0 50045 EL CENTRO REGIONAL MEDICAL CENTER 1415 ROSS AVENUE EL CENTRO CA 92243 (760) 339-7100 120 50046 OJAI VALLEY COMMUNITY HOSPITAL 1306 MARICOPA HWY OJAI CA 93023 (805) 646-1401 660 50047 CA PACIFIC MEDICAL CTR PACIFIC CAMPUS 2333 BUCHANAN STREET SAN FRANCISCO CA 94115 (415) 600-6000 480 50054 SAN GORGONIO MEMORIAL HOSPITAL 600 N HIGHLAND SPRINGS AVE BANNING CA 92220 (909) 845-1121 430 50055 ST LUKES HOSPITAL 3555 ARMY ST SAN FRANCISCO CA 94110 (415) 641-6562 480 50056 ANTELOPE VALLEY HOSPITAL MED CENTER 1600 W AVE J LANCASTER CA 93534 (661) 949-5501 200 50057 KAWEAH DELTA DISTRICT HOSPITAL 400 W MINERAL KING AVE VISALIA CA 93291 (559) 624-2000 640 50058 GLENDALE MEM HOSPITAL & HLTH CENTER 1420 S CENTRAL AVE GLENDALE CA 91204 (818) 502-1900 200 50060 COMMUNITY MEDICAL CENTER FRESNO 2823 FRESNO STREET FRESNO CA 93715 (559) 459-6000 90 50061 ST FRANCIS MED CENTER OF SANTA BARBARA 601 E MICHELTORENA ST SANTA BARBARA CA 93103 (805) 962-7661 520 50063 QUEEN OF ANGELS/HOLYWD PRESB MED CT 1300 N VERMONT AVE LOS ANGELES CA 90028 (213) 413-3000 200 50065 WESTERN MEDICAL CENTER 1001 N TUSTIN AVENUE SANTA ANA CA 92705 (714) 953-3331 400 50067 OAK VALLEY DISTRICT HOSPITAL 350 SOUTH OAK ST OAKDALE CA 95361 (209) 848-4144 600 50069 ST JOSEPH HOSPITAL 1100 W STEWART DR ORANGE CA 92668 (714) 633-9111 400 50070 KAISER FOUNDATION HOSPITAL 1200 EL CAMINO REAL SOUTH SAN FRANCISCOCA 94080 (650) 742-3200 510 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 10 Provider ID Hospital Name Address City State ZIP Telephone County 50071 KAISER FOUNDATION HOSPITAL 900 KIELY BLVD SANTA CLARA CA 95051 (408) 236-6400 530 50072 KAISER FOUNDATION HOSPITAL 1425 S MAIN ST WALNUT CREEK CA 94596 (925) 295-4000 60 50073 KAISER FOUNDATION HOSPITAL VALLEJO 975 SERENO DR VALLEJO CA 94590 (707) 651-1000 580 50075 KAISER FOUNDATION HOSP OAKLAND CAMPUS 280 W MAC ARTHUR BLVD OAKLAND CA 94611 (510) 752-1000 0 50076 KAISER FOUNDATION HOSPITAL 2425 GEARY BLVD SAN FRANCISCO CA 94115 (415) 202-2000 480 50077 SCRIPPS MERCY HOSPITAL 4077 5TH AVE SAN DIEGO CA 92103 (619) 294-8111 470 50078 SAN PEDRO PENINSULA HOSP 1300 W 7TH ST SAN PEDRO CA 90732 (310) 832-3311 200 50079 DOCTORS MEDICAL CTR SAN PABLO CAMPUS 2000 VALE RD SAN PABLO CA 94806 (510) 970-5000 60 50082 ST JOHNS REGIONAL MEDICAL CENTER 1600 N ROSE AVENUE OXNARD CA 93030 (805) 988-2500 660 50084 ST JOSEPHS MED CENTER OF STOCKTON 1800 N CALIFORNIA ST STOCKTON CA 95204 (209) 943-2000 490 50088 SAN LUIS OBISPO GENERAL HOSPITAL 2180 JOHNSON AVE SAN LUIS OBISPO CA 93401 (805) 781-4800 500 50089 COMMUNITY HOSPITAL OF SAN BERNARDINO 1805 MEDICAL CENTER DRIVE SAN BERNARDINO CA 92411 (909) 887-6333 460 50090 SONOMA VALLEY HEALTH CARE DISTRICT 347 ANDRIEUX ST SONOMA CA 95476 (707) 935-5106 590 50091 COMMUNITY HOSP OF HUNTINGTON PARK 2623 E SLAUSEN AVE HUNTINGTON PARK CA 90255 (323) 583-1931 200 50093 SAINT AGNES MEDICAL CENTER 1303 E HERNDON AVE FRESNO CA 93710 (559) 449-3000 90 50095 LAUREL GROVE HOSPITAL 19933 LAKE CHABOT RD CASTRO VALLEY CA 94546 (510) 537-1234 0 50096 DOCTORS HOSPITAL OF WEST COVINA, INC 725 S ORANGE AVE WEST COVINA CA 91790 (626) 338-8481 200 50099 SAN ANTONIO COMMUNITY HOSPITAL 999 SAN BERNARDINO RD UPLAND CA 91786 (714) 985-2811 460 50100 SHARP MEMORIAL HOSPITAL 7901 FROST ST SAN DIEGO CA 92123 (858) 494-8466 470 50101 SUTTER SOLANO MEDICAL CENTER 300 HOSPITAL DR VALLEJO CA 94590 (707) 554-4444 580 50102 PARKVIEW COMMUNITY HOSPITAL 3865 JACKSON ST RIVERSIDE CA 92503 (909) 688-2211 430 50103 WHITE MEMORIAL MEDICAL CENTER 1720 E CESAR AVENUE LOS ANGELES CA 90033 (323) 268-5000 200 50104 ST FRANCIS MEDICAL CENTER 3630 EAST IMPERIAL HIGHWAY LYNWOOD CA 90262 (310) 900-8900 200 50107 MARIAN MEDICAL CENTER 1400 E CHURCH ST SANTA MARIA CA 93454 (805) 739-3200 520 50108 SUTTER GENERAL HOSPITAL 2801 L STREET SACRAMENTO CA 95816 (916) 454-2222 440 50110 LOMPOC HEALTHCARE DISTRICT 508 EAST HICKORY AVENUE LOMPOC CA 93436 (805) 737-3333 520 50111 TEMPLE COMMUNITY HOSPITAL 235 N HOOVER ST LOS ANGELES CA 90004 (213) 382-7252 200 50112 SANTA MONICA - UCLA MEDICAL CENTER 1250 16TH STREET SANTA MONICA CA 90404 (310) 319-4000 200 50113 SAN MATEO COUNTY GENERAL HOSPITAL 222 W 39TH AVE SAN MATEO CA 94403 (650) 573-2222 510 50114 SHERMAN OAKS HOSPITAL AND HEALTH CTR 4929 VAN NUYS BLVD SHERMAN OAKS CA 91403 (818) 981-7111 200 50115 PALOMAR MEDICAL CENTER 555 E VALLEY PARKWAY ESCONDIDO CA 92025 (760) 739-3100 470 50116 NORTHRIDGE HOSPITAL MEDICAL CENTER 18300 ROSCOE BLVD NORTHRIDGE CA 91325 (818) 885-8500 200 50117 MERCY MED CTR MERCED DOMINICAN CAMPUS 2740 M STREET MERCED CA 95340 (209) 384-6444 340 50118 DOCTORS HOSPITAL OF MANTECA 1205 E NORTH ST MANTECA CA 95336 (290) 823-3111 490 50121 HANFORD COMMUNITY MEDICAL CENTER 450 GREENFIELD AVE HANFORD CA 93230 (559) 582-9000 150 50122 DAMERON HOSPITAL ASSOCIATION 525 WEST ACACIA STREET STOCKTON CA 95203 (209) 944-5550 490 50124 VERDUGO HILLS HOSPITAL 1812 VERDUGO BLVD GLENDALE CA 91209 (818) 790-7100 200 50125 REGIONAL MEDICAL CENTER OF SAN JOSE 225 N JACKSON AVE SAN JOSE CA 95116 (408) 259-5000 530 50126 VALLEY PRESBYTERIAN HOSPITAL 1510 VANOWEN ST VAN NUYS CA 91406 (818) 902-3906 200 50127 WOODLAND MEMORIAL HOSPITAL 1325 COTTONWOOD STREET WOODLAND CA 95695 (530) 662-3961 670 50128 TRI-CITY MEDICAL CENTER 4002 VISTA WAY OCEANSIDE CA 92056 (760) 724-8411 470 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 11 Provider ID Hospital Name Address City State ZIP Telephone County 50129 ST BERNARDINE MEDICAL CENTER 2101 N WATERMAN AVE SAN BERNARDINO CA 92404 (909) 881-4440 460 50131 NOVATO COMMUNITY HOSPITAL 1625 HILL RD NOVATO CA 94947 (415) 209-1300 310 50132 SAN GABRIEL VALLEY MEDICAL CENTER 218 S SANTA ANITA ST SAN GABRIEL CA 91776 (626) 289-5454 200 50133 RIDEOUT MEMORIAL HOSPITAL 726 4TH ST MARYSVILLE CA 95901 (530) 749-4660 680 50135 HOLLYWOOD COMMUNITY HOSPITAL 6245 DELONGPRE AVE HOLLYWOOD CA 90028 (323) 462-2271 200 50136 PETALUMA VALLEY HOSPITAL 400 N MCDOWELL BLVD PETALUMA CA 94952 (707) 778-2631 590 50137 KAISER FOUNDATION HOSPITAL 13652 CANTARA ST PANORAMA CITY CA 91402 (818) 375-3333 200 50138 KAISER FOUNDATION HOSPITAL 4867 SUNSET BLVD LOS ANGELES CA 90027 (323) 783-4011 200 50139 KAISER FOUNDATION HOSPITAL 9400 E ROSECRANS AVE BELLFLOWER CA 90706 (562) 461-6007 200 50140 KAISER FOUNDATION HOSPITAL FONTANA 9961 SIERRA AVE FONTANA CA 92335 (909) 427-5500 460 50144 BROTMAN MEDICAL CENTER 3828 DELMAS TERRACE CULVER CITY CA 90231 (310) 836-7000 200 50145 COMM HOSP OF THE MONTEREY PENINSULA 23625 W R HOLMAN HIGHWAY MONTEREY CA 93940 (831) 624-5311 370 50146 CITY OF HOPE NATIONAL MEDICAL CENTER 1500 E DUARTE ROAD DUARTE CA 91010 (626) 359-8111 200 50148 PLUMAS DISTRICT HOSPITAL 1065 BUCKS LAKE RD QUINCY CA 95971 (530) 283-2121 420 50149 CALIFORNIA HOSPITAL MEDICAL CENTER LA 1401 SOUTH GRAND AVENUE LOS ANGELES CA 90015 (213) 748-2411 200 50150 SIERRA NEVADA MEMORIAL HOSPITAL HIGHWAY 20 & GLASSON WAY GRASS VALLEY CA 95945 (530) 274-6000 390 50152 ST FRANCIS MEMORIAL HOSPITAL 900 HYDE ST SAN FRANCISCO CA 94109 (415) 775-4321 480 50153 O'CONNOR HOSPITAL 2105 FOREST AVE SAN JOSE CA 95128 (408) 947-2500 530 50155 MONROVIA COMMUNITY HOSPITAL 323 S HELIOTROPE AVE MONROVIA CA 91016 (626) 359-8341 200 50158 ENCINO-TARZANA REGIONAL MEDICAL CTR 16237 VENTURA BLVD ENCINO CA 91436 (818) 995-5000 200 50159 VENTURA COUNTY MEDICAL CENTER 3291 LOMA VISTA RD VENTURA CA 93003 (805) 652-6075 660 50167 SAN JOAQUIN GENERAL HOSPITAL 500 W HOSPITAL ROAD FRENCH CAMP CA 95231 (209) 468-6300 490 50168 ST JUDE MEDICAL CENTER 101 E VALENCIA MESA DRIVE FULLERTON CA 92835 (714) 992-3965 400 50169 PRESBYTERIAN INTERCOMMUNITY HOSPITAL 12401 E WASHINGTON BLVD WHITTIER CA 90602 (526) 698-0811 200 50172 REDWOOD MEMORIAL HOSPITAL 3300 RENNER DRIVE FORTUNA CA 95540 (707) 725-7328 110 50173 ANAHEIM GENERAL HOSPITAL 3350 W BALL RD ANAHEIM CA 92804 (714) 220-4533 400 50174 SANTA ROSA MEMORIAL HOSPITAL 1165 MONTGOMERY DR SANTA ROSA CA 95405 (707) 525-5300 590 50175 WHITTIER HOSPITAL 15151 JANINE DR WHITTIER CA 90605 (562) 945-3561 200 50177 SANTA PAULA MEMORIAL HOSPITAL 825 N 10TH ST SANTA PAULA CA 93060 (805) 525-7171 660 50179 EMANUEL MEDICAL CENTER INC 825 DELBON AVE TURLOCK CA 95380 (209) 667-4200 600 50180 JOHN MUIR MEDICAL CENTER 1601 YGNACIO VALLEY RD WALNUT CREEK CA 94598 (925) 939-3000 60 50186 SCRIPPS HOSPITAL-EAST COUNTY 1688 EAST MAIN ST EL CAJON CA 92021 (619) 588-9705 470 50188 COMMUNITY HOSP LOS GATOS 815 POLLARD ROAD LOS GATOS CA 95030 (408) 378-6131 530 50189 GEORGE L MEE MEMORIAL HOSPITAL 300 CANAL ST KING CITY CA 93930 (831) 385-6000 370 50191 ST MARY MEDICAL CENTER 1050 LINDEN AVE LONG BEACH CA 90801 (562) 491-9000 200 50192 SIERRA KINGS DISTRICT HOSPITAL 372 W CYPRESS AVE REEDLEY CA 93654 (559) 638-8155 90 50193 SOUTH COAST MEDICAL CENTER 31872 COAST HWY LAGUNA BEACH CA 92677 (949) 499-7193 400 50194 WATSONVILLE COMMUNITY HOSPITAL 75 NIELSON STREET WATSONVILLE CA 95076 (831) 724-4741 540 50195 WASHINGTON HOSPITAL 2000 MOWRY AVE FREMONT CA 94538 (510) 797-1111 0 50196 CENTRAL VALLEY GENERAL HOSPITAL 1025 N DOUTY ST HANFORD CA 93230 (559) 583-2100 150 50197 SEQUOIA HOSPITAL 170 ALAMEDA DE LAS PLUGAS REDWOOD CITY CA 94062 (650) 367-5800 510 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 12 Provider ID Hospital Name Address City State ZIP Telephone County 50204 LANCASTER COMMUNITY HOSPITAL 43830 N 10TH ST W LANCASTER CA 93534 (661) 948-4781 200 50205 EAST VALLEY HOSPITAL MEDICAL CENTER 150 W ALOSTA AVE GLENDORA CA 91740 (626) 335-0231 200 50207 FREMONT MEDICAL CENTER 970 PLUMAS ST YUBA CITY CA 95991 (530) 757-4000 610 50214 GRANADA HILLS COMMUNITY HOSPITAL 10445 BALBOA BLVD GRANADA HILLS CA 91344 (818) 360-1021 200 50215 SAN JOSE MEDICAL CENTER 675 E SANTA CLARA ST SAN JOSE CA 95112 (408) 977-7389 530 50217 FAIRCHILD MEDICAL CENTER 444 BRUCE STREET YREKA CA 96097 (530) 842-4121 570 50219 COAST PLAZA DOCTORS HOSPITAL 13100 S STUDEBAKER RD NORWALK CA 90650 (562) 868-3751 200 50222 SHARP CHULA VISTA MEDICAL CENTER 751 MEDICAL CENTER COURT CHULA VISTA CA 92010 (619) 482-4048 470 50224 HOAG MEMORIAL HOSPITAL PRESBYTERIAN ONE HOAG DRIVE NEWPORT BEACH CA 92663 (949) 645-8600 400 50225 FEATHER RIVER HOSPITAL 5974 PENTZ ROAD PARADISE CA 95969 (530) 877-9361 30 50226 ANAHEIM MEMORIAL HOSPITAL 1111 W LA PALMA AVE ANAHEIM CA 92801 (714) 774-1450 400 50228 SAN FRANCISCO GENERAL HOSPITAL 1001 POTRERO AVE SAN FRANCISCO CA 94110 (415) 206-8000 480 50230 GARDEN GROVE HOSPITAL & MEDICAL CENTER 12601 GARDEN GROVE BLVD GARDEN GROVE CA 92843 (714) 537-5160 400 50231 POMONA VALLEY HOSPITAL MEDICAL CENTER 1798 N GAREY AVE POMONA CA 91767 (909) 865-9883 200 50232 FRENCH HOSPITAL MEDICAL CENTER 1911 JOHNSON AVE SAN LUIS OBISPO CA 93401 (805) 542-6377 500 50234 SHARP CORONADO HOSPITAL AND HLTHCR CTR 250 PROSPECT PLACE CORONADO CA 92118 (619) 435-6251 470 50235 PROVIDENCE SAINT JOSEPH MEDICAL CTR 501 SOUTH BUENA VISTA BURBANK CA 91505 (818) 843-5111 200 50236 SIMI VALLEY HOSPITAL & HEALTH CARE SVC 2975 NORTH SYCAMORE DRIVE SIMI VALLEY CA 93065 (805) 955-6000 660 50238 METHODIST HOSPITAL OF SOUTHERN CA 300 W HUNTINGTON DR ARCADIA CA 91006 (626) 445-4441 200 50239 GLENDALE ADVENTIST MEDICAL CENTER 1509 E WILSON AVE GLENDALE CA 91206 (818) 409-8202 200 50240 CENTINELA HOSPITAL MEDICAL CENTER 555 EAST HARDY STREET INGLEWOOD CA 90301 (310) 680-8166 200 50242 DOMINICAN HOSPITAL 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 (831) 462-7700 540 50243 DESERT REGIONAL MEDICAL CENTER 1150 NORTH INDIAN CANYON DRIVE PALM SPRINGS CA 92262 (760) 323-6511 430 50245 ARROWHEAD REGIONAL MEDICAL CENTER 400 NORTH PEPPER AVENUE COLTON CA 92324 (909) 580-1000 460 50248 NATIVIDAD MEDICAL CENTER 1441 CONSTITUTION BOULEVARD SALINAS CA 93906 (831) 755-4195 370 50251 LASSEN COMMUNITY HOSPITAL 560 HOSPITAL LANE SUSANVILLE CA 96130 (530) 257-5325 170 50253 ORANGE COUNTY COMMUNITY HOSPITAL 6850 LINCOLN AVENUE BUENA PARK CA 90620 (714) 827-1161 400 50254 MARSHALL HOSPITAL MARSHALL WAY PLACERVILLE CA 95667 (530) 626-2636 80 50256 ORTHOPAEDIC HOSPITAL 2400 S FLOWER ST LOS ANGELES CA 90007 (213) 742-1000 200 50257 GOOD SAMARITAN HOSPITAL 901 OLIVE DRIVE BAKERSFIELD CA 93308 (661) 399-4461 140 50261 SIERRA VIEW DISTRICT HOSPITAL 465 W PUTNAM AVE PORTERVILLE CA 93257 (559) 784-1110 640 50262 UCLA MED CTR ADULTS RENAL TRANSPLANT 10833 LE CONTE AVE BH 427, CHS LOS ANGELES CA 90024 (310) 825-9111 200 50264 SAN LEANDRO HOSPITAL 13855 E 14TH STREET SAN LEANDRO CA 94578 (415) 357-6500 0 50270 SCRIPPS MEM HOSPITAL CHULA VISTA 435 H STREET CHULA VISTA CA 92010 (619) 691-7000 470 50272 REDLANDS COMMUNITY HOSPITAL 350 TERRACINA BLVD REDLANDS CA 92373 (909) 335-5500 460 50276 CONTRA COSTA REGIONAL MEDICAL CENTER 2500 ALHAMBRA AVE MARTINEZ CA 94553 (925) 370-5000 60 50277 PACIFIC HOSPITAL OF LONG BEACH 2776 PACIFIC AVE LONG BEACH CA 90806 (562) 595-1911 200 50278 PROVIDENCE HOLY CROSS MEDICAL CENTER 15031 RINALDI ST MISSION HILLS CA 91345 (818) 365-8051 200 50279 HI-DESERT MEDICAL CENTER 6601 WHITEFEATHER ROAD JOSHUA TREE CA 92252 (760) 366-6285 460 50280 MERCY MEDICAL CENTER REDDING 2175 ROSALINE AVE, CLAIRMONT HGTS REDDING CA 96001 (520) 225-6000 550 50281 ALHAMBRA HOSPITAL AND MEDICAL CENTER 100 S RAYMOND AVE ALHAMBRA CA 91801 (626) 570-1606 200 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 13 Provider ID Hospital Name Address City State ZIP Telephone County 50283 VALLEY MEMORIAL HOSPITAL 1111 EAST STANLEY BLVD LIVERMORE CA 94550 (925) 447-7000 0 50289 SETON MEDICAL CENTER 1900 SULLIVAN AVE DALY CITY CA 94015 (650) 992-4000 510 50290 ST JOHNS HOSPITAL HEALTH CENTER 1328 22ND ST SANTA MONICA CA 90404 (310) 829-5511 200 50291 SUTTER MEDICAL CENTER OF SANTA ROSA 3325 CHANATE RD SANTA ROSA CA 95404 (707) 576-4000 590 50292 RIVERSIDE COUNTY REGIONAL MEDICAL CTR 26520 CACTUS AVENUE MORENO VALLEY CA 92555 (909) 486-4000 430 50295 MERCY HOSPITAL 2215 TRUXTUN AVENUE BAKERSFIELD CA 93301 (661) 632-5000 140 50296 HAZEL HAWKINS MEMORIAL HOSPITAL 911 SUNSET DRIVE HOLLISTER CA 95023 (831) 637-5711 450 50298 BARSTOW COMMUNITY HOSPITAL 555 SOUTH SEVENTH AVENUE BARSTOW CA 92311 (760) 256-1761 460 50299 NORTHRIDGE HOSPITAL MED CTR-SHERMAN WY 14500 SHERMAN CIRCLE VAN NUYS CA 91405 (818) 997-0101 200 50300 ST MARY MEDICAL CENTER 18300 HIGHWAY 18 APPLE VALLEY CA 92307 (760) 242-2311 460 50301 UKIAH VALLEY MEDICAL CENTER/HOSPITAL D 275 HOSPITAL DRIVE UKIAH CA 95482 (707) 462-6631 330 50305 ALTA BATES MEDICAL CENTER 3001 COLBY STREET BERKELEY CA 94705 (510) 204-4444 0 50308 EL CAMINO HOSPITAL 2500 GRANT RD MOUNTAIN VIEW CA 94040 (650) 940-7000 530 50309 SUTTER ROSEVILLE MEDICAL CENTER ONE MEDICAL PLAZA ROSEVILLE CA 95661 (916) 781-1000 410 50312 REDDING MEDICAL CENTER 1100 BUTTE STREET REDDING CA 96001 (530) 244-5400 550 50313 SUTTER TRACY COMMUNITY HOSPITAL 1420 N TRACY BLVD TRACY CA 95376 (209) 835-1500 490 50315 KERN MEDICAL CENTER 1830 FLOWER STREET BAKERSFIELD CA 93305 (805) 326-2000 140 50320 ALAMEDA COUNTY MEDICAL CENTER 1411 E 31ST ST OAKLAND CA 94602 (415) 534-8055 0 50324 SCRIPPS MEMORIAL HOSPITAL LA JOLLA 9888 GENESEE AVENUE LA JOLLA CA 92037 (858) 626-4123 470 50325 TUOLUMNE GENERAL HOSPITAL 101 E HOSPITAL ROAD SONORA CA 95370 (209) 533-7001 650 50327 LOMA LINDA UNIVERSITY MEDICAL CENTER 11234 ANDERSON ST LOMA LINDA CA 92354 (909) 558-9200 460 50329 CORONA REGIONAL MEDICAL CENTER 800 SOUTH MAIN STREET CORONA CA 92882 (909) 688-0093 430 50331 HEALDSBURG GENERAL HOSPITAL 1375 UNIVERSITY AVE HEALDSBURG CA 95448 (707) 431-6300 590 50333 SENECA DISTRICT HOSPITAL 130 BRENTWOOD DRIVE CHESTER CA 96020 (530) 258-2121 420 50334 SALINAS VALLEY MEMORIAL HOSPITAL 450 EAST ROMIE LANE SALINAS CA 93901 (831) 757-4333 370 50335 SONORA COMMUNITY HOSPITAL 1 SOUTH FOREST ROAD SONORA CA 95370 (209) 532-3161 650 50336 LODI MEMORIAL HOSPITAL AND WEST GACH 975 S FAIRMONT AVE LODI CA 95240 (209) 334-3411 490 50342 PIONEERS MEMORIAL HOSPITAL DISTRICT 207 W LEGION ROAD BRAWLEY CA 92227 (760) 351-3333 120 50348 UNIV OF CALIFORNIA IRVINE MED CENTER 101 CITY DRIVE SOUTH ORANGE CA 92668 (714) 456-6112 400 50349 CORCORAN DISTRICT HOSPITAL 1310 HANNA AVE CORCORAN CA 93212 (559) 992-5051 150 50350 BEVERLY HOSPITAL 309 W BEVERLY BLVD MONTEBELLO CA 90640 (323) 726-1222 200 50351 TORRANCE MEMORIAL MEDICAL CENTER 3330 LOMITA BLVD TORRANCE CA 90509 (310) 325-9110 200 50352 BARTON MEMORIAL HOSPITAL 2170 SOUTH AVENUE SOUTH LAKE TAHOE CA 96158 (530) 541-3420 80 50353 LITTLE COMPANY OF MARY HOSPITAL 4101 TORRANCE BLVD TORRANCE CA 90503 (310) 540-7676 200 50355 SIERRA VALLEY DISTRICT HOSPITAL 700 THIRD ST PO BOX 178 LOYALTON CA 96118 (530) 993-1225 560 50357 GOLETA VALLEY COTTAGE HOSPITAL 351 S PATTERSON AVE SANTA BARBARA CA 93111 (805) 681-6446 520 50359 TULARE DISTRICT HOSPITAL 869 CHERRY AVE TULARE CA 93274 (559) 688-0821 640 50360 MARIN GENERAL HOSPITAL BOX 2129 250 BON AIR ROAD GREENBRAE CA 94904 (415) 925-7900 310 50366 MARK TWAIN ST JOSEPH'S HOSPITAL 768 MOUNTAIN RANCH RD SAN ANDREAS CA 95249 (209) 754-3521 40 50367 NORTHBAY MEDICAL CENTER 1200 B GALE WILSON BLVD FAIRFIELD CA 94533 (707) 429-7759 580 50369 CITRUS VALLEY MEDICAL CENTER-VQ CAMPUS 1115 S SUNSET AVE WEST COVINA CA 91790 (626) 962-4011 200 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 14 Provider ID Hospital Name Address City State ZIP Telephone County 50373 LAC+USC MEDICAL CENTER 1200 N STATE ST LOS ANGELES CA 90033 (323) 226-2800 400 50376 LAC/HARBOR-UCLA MED CENTER 1000 W CARSON ST TORRANCE CA 90509 (310) 222-2101 400 50377 CHOWCHILLA DISTRICT MEM HOSPITAL 1104 VENTURA AVENUE CHOWCHILLA CA 93610 (559) 665-3718 300 50378 PACIFICA HOSPITAL OF THE VALLEY 9449 SAN FERNANDO RD SUN VALLEY CA 91352 (818) 767-3310 200 50379 MERCY WESTSIDE HOSPITAL 110 EAST NORTH STREET TAFT CA 93268 (661) 763-4211 140 50380 GOOD SAMARITAN HOSPITAL 2425 SAMARITAN DRIVE SAN JOSE CA 95124 (408) 559-2011 530 50382 CITRUS VALLEY MEDICAL CENTER-IC CAMPUS 210 W SAN BERNARDINO ROAD COVINA CA 91723 (626) 814-2468 200 50385 PALM DRIVE HOSPITAL 501 PETALUMA AVE SEBASTOPOL CA 95472 (707) 823-8511 590 50390 HEMET VALLEY MEDICAL CENTER 1117 E DEVONSHIRE HEMET CA 92343 (909) 652-2811 430 50391 SANTA TERESITA HOSPITAL 819 BUENA VISTA STREET DUARTE CA 91010 (626) 359-3248 200 50392 TRINITY GENERAL HOSPITAL 410 N TAYLOR ST WEAVERVILLE CA 96093 (530) 623-5541 630 50393 DOWNEY REGIONAL MEDICAL CENTER 11500 BROOKSHIRE AVENUE DOWNEY CA 90241 (526) 904-5000 200 50394 COMM MEM HOSP OF SAN BUENAVENTURA LOMA VISTA AT BRENT STREET VENTURA CA 93003 (805) 652-5011 660 50396 SANTA BARBARA COTTAGE HOSPITAL PUEBLO AT BATH STREET SANTA BARBARA CA 93105 (805) 682-7111 520 50397 COALINGA REGIONAL MEDICAL CENTER 1191 PHELPS AVENUE COALINGA CA 93210 (559) 935-6400 90 50407 CHINESE HOSPITAL 845 JACKSON ST SAN FRANCISCO CA 94133 (415) 982-2400 480 50410 SANGER HOSPITAL 2558 JENSEN AVE SANGER CA 93657 (559) 875-6571 90 50411 KAISER FOUNDATION HOSPITAL 25825 SOUTH VERMONT AVENUE HARBOR CITY CA 90710 (310) 517-2772 200 50414 MERCY HOSPITAL OF FOLSOM 1650 CREEKSIDE DRIVE FOLSOM CA 95630 (916) 983-7400 440 50417 SUTTER COAST HOSPITAL 800 E WASHINGTON BLVD CRESCENT CITY CA 95531 (707) 464-8860 70 50419 MERCY MEDICAL CENTER MT SHASTA 914 PINE STREET MOUNT SHASTA CA 96067 (530) 926-6111 570 50420 ROBERT F KENNEDY MEDICAL CENTER 4500 116TH STREET HAWTHORNE CA 90250 (310) 349-5522 200 50423 PALO VERDE HOSPITAL 250 N FIRST STREET BLYTHE CA 92225 (760) 922-4115 430 50424 GREEN HOSPITAL OF SCRIPPS CLINIC 10666 NORTH TORREY PINES ROAD LA JOLLA CA 92037 (858) 455-9100 470 50425 KAISER FOUNDATION HOSPITAL 2025 MORSE AVE SACRAMENTO CA 95825 (916) 973-5000 440 50426 WEST ANAHEIM MEDICAL CENTER 3033 W ORANGE AVE ANAHEIM CA 92804 (714) 827-3000 400 50430 MODOC MEDICAL CENTER 228 MCDOWELL ST ALTURAS CA 96101 (530) 233-5131 350 50432 GARFIELD MEDICAL CENTER 525 N GARFIELD AVE MONTEREY PARK CA 91754 (626) 573-2222 200 50433 INDIAN VALLEY DISTRICT HOSPITAL 184 HOT SPRINGS ROAD GREENVILLE CA 95947 (530) 284-7191 420 50434 COLUSA COMMUNITY HOSPITAL 199 E WEBSTER STREET COLUSA CA 95932 (530) 458-5821 50 50435 FALLBROOK HOSPITAL 624 E ELDER ST FALLBROOK CA 92028 (760) 728-1191 470 50438 HUNTINGTON MEMORIAL HOSPITAL 100 W CALIFORNIA BLVD PASADENA CA 91109 (626) 397-5000 200 50441 STANFORD HOSPITAL 300 PASTEUR DRIVE STANFORD CA 94305 (650) 723-4000 530 50444 SUTTER MERCED MEDICAL CENTER 301 E 13TH ST MERCED CA 95340 (209) 724-1557 340 50447 VILLA VIEW COMMUNITY HOSPITAL 5550 UNIVERSITY AVENUE SAN DIEGO CA 92105 (619) 582-2356 470 50448 RIDGECREST REGIONAL HOSPITAL 1081 NORTH CHINA LAKE BLVD RIDGECREST CA 93555 (760) 446-3551 140 50454 UCSF MEDICAL CENTER 505 PARNASSUS AVE SAN FRANCISCO CA 94143 (415) 467-1000 480 50455 SAN JOAQUIN COMMUNITY HOSPITAL 2615 EYE STREET BAKERSFIELD CA 93301 (661) 395-3000 140 50456 COMMUNITY HOSPITAL OF GARDENA 1246 W 155TH ST GARDENA CA 90247 (310) 768-2267 200 50457 ST MARYS HOSPITAL MEDICAL CENTER 450 STANYAN ST SAN FRANCISCO CA 94117 (415) 668-1000 480 50464 DOCTORS MEDICAL CENTER 1441 FLORIDA AVENUE MODESTO CA 95350 (209) 578-1211 600 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 15 Provider ID Hospital Name Address City State ZIP Telephone County 50468 MEMORIAL HOSPITAL OF GARDENA 1145 W REDONDO BEACH BLVD GARDENA CA 90247 (310) 532-4200 200 50469 COLORADO RIVER MEDICAL CENTER 1401 BAILEY AVE NEEDLES CA 92363 (760) 326-4531 460 50470 SELMA COMMUNITY HOSPITAL 1141 ROSE AVE SELMA CA 93662 (559) 445-4664 90 50471 GOOD SAMARITAN HOSPITAL 1225 WILSHIRE BOULEVARD LOS ANGELES CA 90017 (213) 977-2121 200 50476 SUTTER LAKESIDE HOSPITAL 5176 HILL ROAD EAST LAKEPORT CA 95453 (707) 262-5000 160 50477 MIDWAY HOSPITAL MEDICAL CENTER 5925 SAN VICENTE BOULEVARD LOS ANGELES CA 90019 (213) 938-3161 200 50478 SANTA YNEZ VALLEY COTTAGE HOSPITAL 700 ALAMO PINTADO RD SOLVANG CA 93463 (805) 688-6431 520 50481 WEST HILLS MEDICAL CENTER 7300 MEDICAL CENTER DR CANOGA PARK CA 91307 (818) 676-4000 200 50485 LONG BEACH MEMORIAL MEDICAL CENTER 2801 ATLANTIC AVE LONG BEACH CA 90806 (562) 933-2000 200 50488 EDEN MEDICAL CENTER 20103 LAKE CHABOT ROAD CASTRO VALLEY CA 94546 (510) 537-1234 0 50491 SANTA ANA HOSPITAL MEDICAL CENTER INC 1901 N FAIRVIEW ST SANTA ANA CA 92706 (714) 554-1653 400 50492 COMMUNITY MEDICAL CENTER - CLOVIS 2755 HERNDON AVE CLOVIS CA 93612 (559) 324-4000 90 50494 TAHOE FOREST HOSPITAL DISTRICT 10121 PINE AVE TRUCKEE CA 96161 (530) 582-3550 390 50496 MT DIABLO HOSPITAL MEDICAL CENTER 2540 EAST ST CONCORD CA 94520 (925) 674-2002 60 50497 DOS PALOS MEMORIAL HOSPITAL 2118 MARGUERITE ST DOS PALOS CA 93620 (209) 392-6121 340 50498 SUTTER AUBURN FAITH HOSPITAL 11815 EDUCATION STREET AUBURN CA 95603 (530) 888-4500 410 50502 ST VINCENT MEDICAL CENTER 2131 W 3RD ST LOS ANGELES CA 90057 (213) 484-7111 200 50503 SCRIPPS MEMORIAL HOSPITAL ENCINITAS 354 SANTA FE DRIVE ENCINITAS CA 92023 (760) 753-6501 470 50506 SIERRA VISTA REGIONAL MEDICAL CENTER 1010 MURRAY ST SAN LUIS OBISPO CA 93405 (850) 546-7600 500 50510 KAISER FOUNDATION HOSPITAL 99 MONTICELLO RD SAN RAFAEL CA 94903 (415) 444-2000 310 50512 KAISER FOUNDATION HOSPITAL 27400 HESPERIAN BLVD HAYWARD CA 94545 (510) 784-4000 0 50515 KAISER FOUNDATION HOSPITAL 4647 ZION AVE SAN DIEGO CA 92120 (619) 528-5000 470 50516 MERCY SAN JUAN HOSPITAL 6501 COYLE AVE CARMICHAEL CA 95608 (916) 537-5001 440 50517 VICTOR VALLEY COMMUNITY HOSPITAL 15248 11TH ST VICTORVILLE CA 92392 (760) 245-8691 460 50523 SUTTER DELTA MEDICAL CENTER 3901 LONE TREE WAY ANTIOCH CA 94509 (925) 779-7200 60 50526 HUNTINGTON BEACH HOSPITAL 17772 BEACH BLVD HUNTINGTON BEACH CA 92647 (714) 355-7985 400 50528 MEMORIAL HOSPITAL LOS BANOS 520 WEST I ST LOS BANOS CA 93635 (209) 826-0591 340 50531 BELLFLOWER MEDICAL CENTER 9542 E ARTESIA BLVD BELLFLOWER CA 90706 (562) 925-8355 200 50534 JOHN F KENNEDY MEMORIAL HOSPITAL, INC 47-111 MONROE ST INDIO CA 92201 (760) 347-6191 430 50535 COASTAL COMMUNITIES HOSPITAL 2701 S BRISTOL ST SANTA ANA CA 92704 (714) 754-5454 400 50537 SUTTER DAVIS HOSPITAL 2000 SUTTER PLACE DAVIS CA 95616 (530) 756-6440 670 50539 REDBUD COMMUNITY HOSPITAL 15630 18TH AVE HWY 53 CLEARLAKE CA 95422 (707) 995-5826 160 50541 KAISER FOUNDATION HOSPITAL 1150 VETERANS BLVD REDWOOD CITY CA 94063 (650) 299-2000 510 50542 KERN VALLEY HEALTHCARE DISTRICT 6412 LAUREL AVE LAKE ISABELLA CA 93240 (760) 379-6667 140 50543 COLLEGE HOSPITAL COSTA MESA 301 VICTORIA STREET COSTA MESA CA 92627 (714) 642-2734 400 50545 LANTERMAN DEVELOPMENTAL CENTER 3530 W POMONA BLVD POMONA CA 91768 (909) 595-1221 200 50546 PORTERVILLE DEVELOPMENTAL CENTER 26501 AVENUE 140 PORTERVILLE CA 93258 (209) 782-2222 640 50547 SONOMA DEVELOPMENT CENTER P O BOX 1493 ELDRIDGE CA 95431 (707) 938-6393 590 50548 FAIRVIEW DEVELOPMENTAL CENTER 2501 HARBOR BLVD COSTA MESA CA 92626 (714) 957-5000 400 50549 LOS ROBLES REGIONAL MEDICAL CENTER 215 WEST JANSS ROAD THOUSAND OAKS CA 91360 (805) 497-2727 660 50550 CHAPMAN MEDICAL CENTER 2601 E CHAPMAN AVE ORANGE CA 92869 (714) 633-0011 400 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 16 Provider ID Hospital Name Address City State ZIP Telephone County 50551 LOS ALAMITOS MEDICAL CENTER 3751 KATELLA AVENUE LOS ALAMITOS CA 90720 (714) 826-6400 400 50552 MOTION PICTURE & TELEVISION HOSPITAL 23388 MULHOLLAND DRIVE WOODLAND HILLS CA 91364 (818) 876-1888 200 50557 MEMORIAL HOSPITAL MEDICAL CENTER 1700 COFFEE RD MODESTO CA 95355 (209) 526-4500 600 50561 KAISER FOUNDATION HOSPITAL 6041 CADILLAC AVE LOS ANGELES CA 90034 (323) 783-4011 200 50567 MISSION HOSPITAL REGIONAL MED CENTER 27700 MEDICAL CENTER RD MISSION VIEJO CA 92691 (949) 364-1400 400 50568 MADERA COMMUNITY HOSPITAL 1250 E ALMOND AVE MADERA CA 93637 (559) 675-5555 300 50569 MENDOCINO COAST DISTRICT HOSPITAL 700 RIVER DR FORT BRAGG CA 95437 (707) 961-4697 330 50570 FOUNTAIN VALLEY REGIONAL HOSPITAL 17100 EUCLID STREET FOUNTAIN VALLEY CA 92708 (714) 966-7200 400 50571 SURBURBAN MEDICAL CENTER 16453 SO COLORADO AVE PARAMOUNT CA 90723 (562) 531-3110 200 50573 EISENHOWER MEDICAL CENTER 39-000 BOB HOPE DRIVE RANCHO MIRAGE CA 92270 (760) 340-3911 430 50575 TRI-CITY REGIONAL MEDICAL CENTER 21530 S PIONEER BLVD HAWAIIAN GARDENS CA 90716 (562) 860-0401 200 50577 SANTA MARTA HOSPITAL 319 N HUMPHREYS AVE LOS ANGELES CA 90022 (323) 266-6500 200 50578 LAC/MARTIN LUTHER KING JR GEN HOSPITAL 12021 S WILMINGTON AVE LOS ANGELES CA 90059 (310) 668-9646 400 50579 CENTURY CITY HOSPITAL 2070 CENTURY PARK EAST LOS ANGELES CA 90067 (310) 553-6211 200 50580 LA PALMA INTERCOMMUNITY HOSPITAL 7901 WALKER STREET LA PALMA CA 90623 (714) 670-7400 400 50581 LAKEWOOD REGIONAL MEDICAL CENTER 3700 E SOUTH ST LAKEWOOD CA 90712 (562) 531-2550 200 50583 ALVARADO HOSPITAL MEDICAL CENTER 6655 ALVARADO RD SAN DIEGO CA 92120 (619) 287-3270 470 50584 DRS' HOSPITAL MED CENTR OF MONTCLAIR 5000 SAN BERNARDINO ROAD MONTCLAIR CA 91763 (909) 625-5411 460 50585 SAN CLEMENTE HOSPITAL AND MED CENTER 654 CAMINO DE LOS MARES SAN CLEMENTE CA 92673 (949) 496-1122 400 50586 CHINO VALLEY MEDICAL CENTER 5451 WALNUT AVE CHINO CA 91710 (909) 627-6111 460 50588 SAN DIMAS COMMUNITY HOSPITAL 1350 W COVINA BLVD SAN DIMAS CA 91773 (909) 599-6811 200 50589 PLACENTIA LINDA HOSPITAL 1301 N ROSE DRIVE PLACENTIA CA 92870 (714) 993-2000 400 50590 METHODIST HOSPITAL 7500 TIMBERLAKE WAY SACRAMENTO CA 95823 (916) 423-6010 440 50591 MONTEREY PARK HOSPITAL 900 S ATLANTIC BLVD MONTEREY PARK CA 91754 (626) 570-9000 200 50592 BREA COMMUNITY HOSPITAL 380 W CENTRAL AVE BREA CA 92821 (714) 529-0211 400 50594 WESTERN MEDICAL CENTER HOSP ANAHEIM 1025 S ANAHEIM BLVD ANAHEIM CA 92805 (714) 533-6220 400 50597 FOOTHILL PRESBYTERIAN HOSPITAL 250 S GRAND AVE GLENDORA CA 91740 (626) 963-8411 200 50599 UNIV OF CALIFORNIA DAVIS MED CENTER 2315 STOCKTON BLVD SACRAMENTO CA 95817 (916) 734-3667 440 50601 AMI TARZANA REGIONAL MEDICAL CENTER 18321 CLARK ST TARZANA CA 91356 (818) 708-5148 200 50603 SADDLEBACK MEMORIAL MEDICAL CENTER 24451 HEALTH CENTER DRIVE LAGUNA HILLS CA 92653 (949) 837-4500 400 50604 SANTA TERESA COMMUNITY HOSPITAL 250 HOSPITAL PARKWAY SAN JOSE CA 95119 (408) 972-7000 530 50608 DELANO REGIONAL MEDICAL CENTER 1401 GARCES HIGHWAY DELANO CA 93215 (661) 725-4800 140 50609 KAISER FOUNDATION HOSPITAL ANAHEIM 441 N LAKEVIEW AVENUE ANAHEIM CA 92807 (714) 279-4000 400 50613 ST CATHERINE HOSPITAL MARINE BLVD AND ETHELDORE ST MOSS BEACH CA 94038 (650) 563-7100 510 50615 GREATER EL MONTE COMMUNITY HOSPITAL 1701 SANTA ANITA AVE SOUTH EL MONTE CA 91733 (626) 350-7975 200 50616 ST JOHNS PLEASANT VALLEY HOSPITAL 2309 ANTONIO AVE CAMARILLO CA 93010 (805) 988-3538 660 50618 BEAR VALLEY COMMUNITY HOSPITAL 41870 GARSTIN DR BIG BEAR LAKE CA 92315 (909) 866-6501 460 50623 LAC/HIGH DESERT HOSPITAL 44900 N 60TH ST W LANCASTER CA 93534 (661) 948-8581 400 50624 HENRY MAYO NEWHALL MEMORIAL HOSPITAL 23845 W MCBEAN PKWY VALENCIA CA 91355 (661) 253-8000 200 50625 CEDARS-SINAI MEDICAL CENTER 8700 BEVERLY BLVD LOS ANGELES CA 90048 (310) 423-5511 200 50633 TWIN CITIES COMMUNITY HOSPITAL 1100 LAS TABLAS ROAD TEMPLETON CA 93465 (805) 434-3500 500 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 17 Provider ID Hospital Name Address City State ZIP Telephone County 50636 POMERADO HOSPITAL 15615 POMERADO ROAD POWAY CA 92064 (858) 613-5672 470 50641 EAST LOS ANGELES DOCTORS HOSPITAL 4060 WHITTIER BLVD LOS ANGELES CA 90023 (323) 268-5514 200 50643 PHS INDIAN HEALTH SERVICE HOSPITAL WINTERHAVEN CA 92283 (714) 572-0217 120 50644 LOS ANGELES METROPOLITAN MEDICAL CTR 2231 S WESTERN AVE LOS ANGELES CA 90018 (323) 730-7300 200 50660 USC KENNETH NORRIS JR CANCER HOSPITAL 1441 EASTLAKE AVE LOS ANGELES CA 90033 (323) 865-3000 200 50662 AGNEWS STATE HOSPITAL 3500 ZANKER ROAD SAN JOSE CA 95134 (408) 451-6000 530 50663 LOS ANGELES COMMUNITY HOSPITAL 4081 E OLYMPIC BLVD LOS ANGELES CA 90023 (323) 367-0477 200 50667 NELSON HOLDERMAN HOSPITAL CALIFORNIA VETERANS HOME YOUNTVILLE CA 94599 (707) 944-4600 380 50668 LAGUNA HONDA HOSPITAL 375 LAGUNA HONDA BLVD SAN FRANCISCO CA 94116 (415) 759-2367 480 50674 KAISER FOUNDATION HOSP SO SACRAMENTO 6600 BRUCEVILLE ROAD SACRAMENTO CA 95823 (916) 688-2000 440 50677 KAISER FOUNDATION HOSPITAL 5601 DE SOTO WOODLAND HILLS CA 91367 (818) 719-3800 200 50678 ORANGE COAST MEMORIAL MEDICAL CENTER 9920 TALBERT AVENUE FOUNTAIN VALLEY CA 92708 (714) 387-7549 400 50680 NORTHBAY VACAVALLEY HOPSITAL 1000 NUT TREE ROAD VACAVILLE CA 95688 (707) 446-4000 580 50681 SAN VICENTE HOSPITAL 6000 SAN VICENTE BLVD LOS ANGELES CA 90036 (323) 937-2504 200 50682 KINGSBURG MEDICAL CENTER 1200 SMITH ST KINGSBURG CA 93631 (559) 897-5841 90 50684 MENIFEE VALLEY MEDICAL CENTER 28400 MCCALL BLVD SUN CITY CA 92381 (909) 766-3335 430 50686 KAISER FOUNDATION HOSPITAL, RIVERSIDE 10917 MAGNOLIA AVENUE RIVERSIDE CA 92505 (909) 353-2000 430 50688 SAINT LOUISE HOSPITAL & HEALTH CENTER 9400 NO NAME UNO GILROY CA 95020 (408) 848-2000 530 50689 SAN RAMON REGIONAL MEDICAL CTR 6001 NORRIS CANYON ROAD SAN RAMON CA 94583 (925) 275-9200 60 50690 KAISER FOUNDATION HOSPITAL-SANTA ROSA 401 BICENTENNIAL WAY SANTA ROSA CA 95403 (707) 571-4000 590 50693 IRVINE REGIONAL HOSPITAL & MEDICAL CTR 16200 SAND CANYON AVE IRVINE CA 92618 (949) 753-2000 400 50694 MORENO VALLEY MEDICAL CENTER 27300 IRIS AVENUE MORENO VALLEY CA 92555 (909) 243-0811 430 50695 ST DOMINIC'S HOSPITAL 1777 WEST YOSEMITE AVE MANTECA CA 95336 (209) 865-3555 490 50696 USC UNIVERSITY HOSPITAL 1500 SAN PABLO ST LOS ANGELES CA 90033 (323) 442-8500 200 50697 PATIENTS' HOSPITAL OF REDDING 2900 EUREKA WAY REDDING CA 96001 (530) 225-8700 550 50698 SAN DIEGO HOSPICE ACUTE CARE CENTER 4311 THIRD AVE SAN DIEGO CA 92103 (619) 688-1600 470 50699 NORTHERN CALIFORNIA REHAB HOSPITAL 2801 EUREKA WAY REDDING CA 96001 (530) 246-9000 550 50701 RANCHO SPRINGS MEDICAL CENTER 25500 MEDICAL CENTER DRIVE MURRIETA CA 92362 (909) 696-6000 430 50704 MISSION COMMUNITY HOSPITAL - PANORAMA 14850 ROSCOE BLVD PANORAMA CITY CA 91402 (818) 787-2222 200 50707 RECOVERY INN OF MENLO PARK 570 WILLOW ROAD MENLO PARK CA 94025 (650) 324-8500 510 50708 FRESNO SURGERY CENTER 6125 NORTH FRESNO ST FRESNO CA 93710 (559) 431-8000 90 50709 DESERT VALLEY HOSPITAL 16850 BEAR VALLEY RD VICTORVILLE CA 92392 (760) 241-8000 460 50710 KAISER FOUNDATION HOSPITAL - FRESNO 7300 NORTH FRESNO ST FRESNO CA 93720 (559) 448-4500 90 50713 LINCLON HOSPITAL MEDICAL CENTER 443 SOUTH SOTO STREET LOS ANGELES CA 90033 (323) 261-1181 200 50714 SUTTER MATERNITY AND SURGERY CENTER 2900 CHANTICLEER AVENUE SANTA CRUZ CA 95065 (831) 477-2200 540 50717 LAC/RANCHO LOS AMIGOS NATIONAL MED CTR 7601 EAST IMPERIAL HIGHWAY DOWNEY CA 90242 (562) 401-7022 400 50718 VALLEY PLAZA DOCTORS HOSPITAL 2224 MEDICAL CENTER DRIVE PERRIS CA 92571 (909) 943-4555 430 50720 TUSTIN HOSPITAL AND MEDICAL CENTER 14662 NEWPORT AVENUE TUSTIN CA 92680 (714) 838-9600 400 50722 SHARP MARY BIRCH HOSPITAL FOR WOMEN 3003 HEALTH CENTER DRIVE SAN DIEGO CA 92123 (858) 541-3400 470 50723 KAISER FOUNDATION HOSPITAL 1011 BALDWIN PARK BLVD BALDWIN PARK CA 91706 (626) 851-1011 200 50724 BAKERSFIELD HEART HOSPITAL 3001 SILLECT AVENUE BAKERSFIELD CA 93308 (661) 316-6000 140 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 18 Provider ID Hospital Name Address City State ZIP Telephone County 50725 CITY OF ANGELES MEDICAL CENTER 1711 WEST TEMPLE STREET LOS ANGELES CA 90026 (213) 989-6100 200 50726 STANISLAUS SURGICAL HOSPITAL 1421 OAKDALE ROAD MODESTO CA 95355 (209) 572-2700 600 50727 COMMUNITY HOSPITAL OF LONG BEACH 1720 TERMINO AVENUE LONG BEACH CA 90804 (562) 494-0600 200 50728 SUTTER WARRACK HOSPITAL 2449 SUMMERFIELD ROAD SANTA ROSA CA 95405 (707) 542-9030 590 50729 DANIEL FREEMAN MEMORIAL HOSPITAL 333 NORTH PRAIRIE AVENUE INGLEWOOD CA 90301 (310) 674-7050 200 50730 DANIEL FREEMAN MARINA HOSPITAL 4650 LINCOLN BLVD MARINA DEL REY CA 90291 (310) 823-8911 200 51300 EASTERN PLUMAS HEALTH CARE 500 FIRST STREET PORTOLA CA 96122 (530) 832-4277 420 51301 TEHACHAPI HOSPITAL 115 WEST STREET TEHACHAPI CA 93581 (661) 822-3241 140 51302 SOUTHERN INYO HOSPITAL 501 EAST LOCUST STREET LONE PINE CA 93545 (760) 876-5501 130 51303 MAMOTH HOSPITAL 85 SIERRA PARK ROAD, PO BOX 3399 MAMMOTH LAKES CA 93546 (760) 934-3311 360 51304 JOHN C FREMONT HEATHCARE DISTRICT 5189 HOSPITAL ROAD MARIPOSA CA 95338 (209) 966-3631 320 51305 MAYERS MEMORIAL HOSPITAL 43563 HWY 299 EAST FALL RIVER MILLS CA 96028 (530) 336-5511 550 51306 GLENN MEDICAL CENTER 1133 W SYCAMORE ST WILLOWS CA 95988 (530) 934-1818 100 51307 AVALON MUNICIPAL HOSPITAL 100 FALLS CANYON ROAD AVALON CA 90704 (310) 510-0700 200 51308 SUPRISE VALLEY COMMUNITY HOSPITAL MAIN AND WASHING PO BOX 246 CEDARVILLE CA 96104 (530) 279-6111 350 51309 JERALD PHELPS COMMUNITY HOSPITAL 733 CEDAR ST GARBERVILLE CA 95542 (707) 923-3921 110 51310 FRANK R HOWARD MEMORIAL HOSPITAL 1 MADRONE STREET WILLITS CA 95490 (707) 459-6801 330 51311 BIGGS GRIDLEY MEMORIAL HOSPITAL 240 SPRUCE STREET EAST GRIDLEY CA 95948 (530) 846-9021 30 51990 SUNLAND HOME CORPORATION 691 SPARTA DRIVE ENCINITAS CA 92024 (760) 944-2976 0 51991 BROADVIEW INC 4570 GRIFFIN AVENUE LINCOLN HEIGHTS CA 90031 (213) 221-9174 0 52031 BARLOW HOSPITAL 2000 STADIUM WAY LOS ANGELES CA 90026 (213) 250-4200 200 52032 VENCOR HOSPITAL - LOS ANGELES 5525 SLAUSON AVENUE LOS ANGELES CA 90056 (310) 642-0325 200 52033 VENCOR HOSPITAL - SACRAMENTO 223 FARGO WAY FOLSOM CA 95630 (916) 351-9151 440 52034 KINDRED HOSPITAL - SF BAY AREA 2800 BENEDICT DRIVE SAN LEANDRO CA 94577 (510) 357-8300 0 52035 KINDRED HOSPITAL WESTMINSTER 200 HOSPITAL CIRCLE WESTMINSTER CA 92683 (714) 893-4541 400 52036 KINDRED HOSPITAL - SAN DIEGO 1940 EL CAJON BLVD SAN DIEGO CA 92104 (619) 543-4500 470 52037 VENCOR HOSPITAL - ONTARIO 550 NORTH MONTEREY ONTARIO CA 91764 (909) 391-0333 460 52038 SPECIALITY HOSPITAL OF SOUTHERN CALIF 14900 E IMPERIAL HWY LA MIRADA CA 90637 (562) 944-1900 200 52039 KINDRED HOSPITAL BREA 875 N BREA BLVD BREA CA 92821 (714) 529-6842 400 52043 KENTFIELD MEDICAL HOSPITAL 1125 SIR FRANCIS DRAKE BLVD KENTFIELD CA 94904 (415) 456-9680 310 52044 CONTINENTAL REHABILITATION HOSPITAL 555 WASHINGTON STREET SAN DIEGO CA 92103 (619) 260-8300 470 53027 CASA COLINA HOSP FOR REHAB MEDICINE 255 E BONITA AVE POMONA CA 91767 (909) 981-9450 200 53028 REHAB INSTITUTE AT SANTA BARBARA,THE 2415 DE LA VINA SANTA BARBARA CA 93105 (805) 687-7444 520 53031 HEALTHSOUTH BAKERSFIELD REHAB HOSPITAL 5001 COMMERCE DRIVE BAKERSFIELD CA 93309 (661) 323-5500 140 53032 SAN JOAQUIN VALLEY REHABILITATION HOSP 7173 N SHARON AVE FRESNO CA 93720 (559) 436-3600 90 53034 HEALTHSOUTH TUSTIN REHABILITATION HOSP 14851 YORBA STREET TUSTIN CA 92780 (714) 832-9200 400 53036 MODESTO REHAB HOSPITAL 730 17TH ST MODESTO CA 95354 (925) 586-2035 600 53037 SUN HEALTH ROBERT H BALLARD REHAB HOSP 1760 WEST 16TH ST SAN BERNARDINO CA 92411 (909) 473-1275 460 53300 CHILDRENS HOSPITAL CENTRAL CALIFORNIA 9300 VALLEY CHILDRENS PLACE MADERA CA 93638 (559) 353-5116 90 53301 CHILDRENS HOSP MED CTR 51 ST AND GROVE STREETS OAKLAND CA 94609 (510) 428-3000 0 53302 CHILDRENS HOSP OF LOS ANGELES 4650 SUNSET BLVD LOS ANGELES CA 90054 (323) 669-2164 200 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 19 Provider ID Hospital Name Address City State ZIP Telephone County 53303 CHILDRENS HOSPITAL - SAN DIEGO 3020 CHILDRENS WAY SAN DIEGO CA 92123 (858) 966-5968 470 53304 CHILDREN'S HOSPITAL OF ORANGE COUNTY 455 SOUTH MAIN STREET ORANGE CA 92668 (714) 997-3000 400 53305 LUCILE SALTER PACKARD CHILDREN'S HSP 725 WELCH ROAD PALO ALTO CA 94304 (650) 497-8000 530 53306 CHILDREN'S HOSPITAL AT MISSION 27700 MEDICAL CENTER RD, 5TH FLOOR MISSION VIEJO CA 92691 (949) 365-2408 400 53308 HEALTHBRIDGE CHILDRENS REHAB HOSPITAL 393 S TUSTIN STREET ORANGE CA 92866 (714) 289-2400 400 53309 MILLER CHILDREN'S HOSPITAL 2801 ATLANTIC AVENUE LONG BEACH CA 90806 (562) 933-8001 200 54009 U C L A NEUROPSYCHIATRIC HOSP CLINIC 760 WESTWOOD PLAZA LOS ANGELES CA 90024 (310) 206-9842 200 54028 GATEWAYS HOSP MENTAL HEALTH CTR 1891 EFFIE ST LOS ANGELES CA 90026 (213) 666-0171 200 54032 BHC ALHAMBRA HOSP 4619 N ROSEMEAD BLVD ROSEMEAD CA 91770 (626) 286-1191 200 54053 DEL AMO HOSPITAL 3270 W LOMITA BLVD TORRANCE CA 90505 (310) 530-1151 200 54055 COLLEGE HOSPITAL 10802 COLLEGE PLACE CERRITOS CA 90701 (562) 924-9581 200 54069 CHARTER BHS OF SO CA CHARTER OAK 1161 E COVINA BLVD COVINA CA 91724 (626) 966-1632 200 54074 CALIFORNIA SPECIALTY HOSPITAL 525 OREGON ST VALLEJO CA 94590 (707) 557-8222 580 54075 ALVARADO PARKWAY INSTITUTE BEHAVIORAL 7050 PARKWAY DRIVE LA MESA CA 91942 (619) 465-4411 470 54077 VISTA DEL MAR HOSPITAL 801 SENECA ST VENTURA CA 93001 (805) 653-6434 660 54078 COLUMBIA LAS ENCINAS HOSPITAL 2900 E DEL MAR BLVD PASADENA CA 91107 (818) 795-9901 200 54083 KEDREN COMMUNITY HEALTH CENTER, INC 4211 SOUTH AVALON BLVD LOS ANGELES CA 90011 (213) 233-0425 200 54087 SIERRA VISTA HOSPITAL 8001 BRUCEVILLE ROAD SACRAMENTO CA 95823 (916) 423-2000 440 54089 HEBREW HOME FOR THE AGED DISABLED 302 SILVER AVE SAN FRANCISCO CA 94112 (415) 334-2500 480 54091 CEDAR VISTA HOSPITAL 7171 NORTH CEDAR AVE FRESNO CA 93710 (209) 449-8000 90 54093 LOMA LINDA BEHAVIORAL MED CTR 27072 BARTON RD REDLANDS CA 92373 (714) 793-9333 460 54095 AURORA SAN DIEGO 11878 AVENUE OF INDUSTRY SAN DIEGO CA 92128 (619) 487-3200 470 54096 SUTTER CENTER FOR PSYCHIATRY 7700 FOLSOM BLVD SACRAMENTO CA 95826 (916) 386-3000 440 54104 HERITAGE OAKS HOSPITAL 4250 AUBURN BLVD SACRAMENTO CA 95841 (916) 489-3336 440 54105 PINE GROVE HOSPITAL 7011 SHOUP AVE CANOGA PARK CA 91307 (818) 348-0500 200 54108 SHASTA COUNTY IN-PATIENT MTL HLTH SERS 2640 BRESLAUER WAY REDDING CA 96049 (530) 225-5233 550 54110 FREMONT HOSPITAL 39001 SUNDALE DRIVE FREMONT CA 94538 (510) 796-1100 0 54111 CANYON RIDGE HOSPITAL 5353 G STREET CHINO CA 91710 (909) 590-3700 460 54114 SAN DIEGO COUNTY PSYCHIATRIC HOSPITAL 3851 ROSECRANS ST SAN DIEGO CA 92110 (619) 692-8211 470 54122 NAPA STATE HOSPITAL 2100 NAPA VALLEJO HIGHWAY NAPA CA 94558 (707) 253-5454 380 54123 ST JOSEPH'S BEHAVIORAL HEALTH CENTER 2510 N CALIFORNIA ST STOCKTON CA 95204 (209) 461-2000 490 54124 SEMPERVIRENS 720 WOOD ST EUREKA CA 95501 (707) 268-2990 110 54125 SANTA BARBARA CNTY PSYCH HLTH FACILITY 315 CAMINO DEL REMEDIO SANTA BARBARA CA 93110 (805) 681-5244 520 54130 KNOLLWOOD PSYCH & CHEMICAL DEPEND CTR 5900 BROCKTON AVE RIVERSIDE CA 92506 (909) 275-8400 430 54131 MT DIABLO MEDICAL PAVILION 2740 GRANT ST CONCORD CA 94524 (925) 674-4101 60 54133 METROPOLITAN STATE HOSPITAL 11400 S NORWALK BLVD NORWALK CA 90650 (562) 651-2245 200 54135 NEWPORT BAY HOSPITAL 1501 E 16TH ST NEWPORT BEACH CA 92663 (949) 650-9750 400 54141 TELECARE/SOLANO PARK 2101 COURAGE DRIVE FAIRFIELD CA 94533 (707) 435-2136 580 54144 LANGLEY PORTER PSYCHIATRIC INSTITUTE 401 PARNASSUS AVENUE SAN FRANCISCO CA 94143 (415) 476-7885 480 60001 NORTH COLORADO MEDICAL CENTER 1801 16TH STREET GREELEY CO 80631 (970) 352-4121 610 60003 LONGMONT UNITED HOSPITAL 1950 MOUNTAIN VIEW AVE LONGMONT CO 80501 (303) 651-5111 60 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 20 Provider ID Hospital Name Address City State ZIP Telephone County 60004 PLATTE VALLEY MEDICAL CTR 1850 EGBERT ST BRIGHTON CO 80601 (303) 659-1531 0 60006 MONTROSE MEMORIAL HOSPITAL 800 S 3RD ST MONTROSE CO 81401 (970) 249-2211 420 60007 PROWERS MEDICAL CENTER 401 KENDALL DRIVE LAMAR CO 81052 (719) 336-4343 490 60008 SAN LUIS VALLEY REGIONAL MED CTR 106 BLANCA AVE ALAMOSA CO 81101 (719) 589-2511 10 60009 EXEMPLA LUTHERAN MEDICAL CTR 8300 W 38TH AVE WHEAT RIDGE CO 80033 (303) 425-2417 290 60010 POUDRE VALLEY HOSPITAL 1024 S LEMAY AVE FORT COLLINS CO 80524 (970) 495-7000 340 60011 DENVER HEALTH MEDICAL CENTER 777 BANNOCK ST DENVER CO 80204 (303) 436-6000 150 60012 CENTURA HEALTH-ST MARY CORWIN MED CTR 1008 MINNEQUA AVE PUEBLO CO 81004 (719) 560-4000 500 60013 MERCY MEDICAL CENTER OF DURANGO 375 E PARK AVE DURANGO CO 81301 (970) 247-4311 330 60014 PRESBYTERIAN/ST LUKE'S MEDICAL CTR 1719 E 19TH AVE DENVER CO 80218 (303) 839-6100 150 60015 CENTURA HEALTH-ST ANTHONY CENTRAL HOSP 4231 W 16TH AVE DENVER CO 80204 (303) 629-4350 150 60016 CENTURA HLTH-ST THOMAS MORE HOSPITAL 1338 PHAY AVE CANON CITY CO 81212 (719) 269-2000 210 60018 SOUTHWEST HEALTH SYSTEM INC 1311 N MILDRED RD CORTEZ CO 81321 (970) 565-6666 140 60020 PARKVIEW MEDICAL CTR INC 400 W 16TH ST PUEBLO CO 81003 (719) 584-4000 500 60022 MEMORIAL HOSPITAL 1400 E BOULDER ST COLORADO SPRINGS CO 80909 (719) 365-5000 200 60023 ST MARYS HOSPITAL AND MEDICAL CENTER 2635 NORTH 7TH ST BOX 1628 GRAND JUNCTION CO 81502 (970) 244-2273 380 60024 UNIVERSITY HOSPITAL 4200 E 9TH AVE DENVER CO 80262 (303) 372-9200 150 60027 BOULDER COMM HOSP 311 MAPLETON AVE BOULDER CO 80301 (303) 440-2273 60 60028 EXEMPLA INC SAINT JOSEPH HOSP 1835 FRANKLIN ST DENVER CO 80218 (303) 837-7111 150 60029 ST VINCENT GENERAL HOSPITAL DISTRICT 822 W 4TH ST LEADVILLE CO 80461 (719) 486-0230 320 60030 MCKEE MEDICAL CENTER 2000 BOISE AVE LOVELAND CO 80538 (970) 669-4640 340 60031 CENTURA HLTH/PENROSE ST FRANCIS HOSP 2215 N CASCADE AVE COLORADO SPRINGS CO 80907 (719) 776-5000 200 60032 ROSE MEDICAL CTR 4567 E 9TH AVE DENVER CO 80220 (303) 320-2121 150 60033 MOUNT SAN RAFAEL HOSPITAL 410 BENEDICTA AVE TRINIDAD CO 81082 (719) 846-9213 350 60034 SWEDISH MEDICAL CTR 501 E HAMPDEN AVE ENGLEWOOD CO 80110 (303) 788-6277 20 60036 ARKANSAS VALLEY REGIONAL MED CENTER 1100 CARSON AVENUE LA JUNTA CO 81050 (719) 384-5412 440 60041 PIONEERS HOSPITAL OF RIO BLANCO 345 CLEVELAND MEEKER CO 81641 (303) 878-5047 510 60042 CLAGETT MEMORIAL HOSPITAL 707 EAST FIFTH ST BOX 72 RIFLE CO 81650 (303) 625-1510 220 60043 KEEFE MEMORIAL HOSPITAL 602 N 6TH W ST PO BOX 578 CHEYENNE WELLS CO 80810 (719) 767-5661 80 60044 COLORADO PLAINS MEDICAL CTR 1000 LINCOLN ST FORT MORGAN CO 80701 (970) 867-3391 430 60049 YAMPA VALLEY MEDICAL CTR 1024 CENTRAL PARK DR STEAMBOAT SPRINGS CO 80487 (970) 879-1322 530 60050 HEART OF THE ROCKIES REG MED CENTER 448 E FIRST ST SALIDA CO 81201 (719) 539-6661 70 60054 COMMUNITY HOSPITAL 2021 N 12TH ST GRAND JUNCTION CO 81501 (970) 256-6320 380 60057 ASPEN VALLEY HOSPITAL 0401 CASTLE CREEK RD ASPEN CO 81611 (970) 544-1186 480 60064 CENTURA HLTH-PORTER ADVENTIST HOSPITAL 2525 S DOWNING ST DENVER CO 80210 (303) 778-1955 150 60065 NORTH SUBURBAN MEDICAL CTR 9191 GRANT ST THORNTON CO 80229 (303) 450-4404 0 60070 GUNNISON VALLEY HOSPITAL 214 E DENVER AVE GUNNISON CO 81230 (970) 641-1456 250 60071 DELTA COUNTY MEMORIAL HOSPITAL 100 STAFFORD LN PO BOX 10100 DELTA CO 81416 (970) 874-7681 140 60075 VALLEY VIEW HOSPITAL ASSN 1906 BLAKE AVE GLENWOOD SPRINGS CO 81601 (970) 945-6535 70 60076 STERLING REGIONAL MED CTR 615 FAIRHURST ST STERLING CO 80751 (303) 522-0122 370 60090 KREMMLING MEMORIAL HOSPITAL DISTRICT 212 S 4TH ST KREMMLING CO 80459 (303) 724-3442 240 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 21 Provider ID Hospital Name Address City State ZIP Telephone County 60096 VAIL VALLEY MEDICAL CENTER 181 W MEADOW DR VAIL CO 81657 (970) 476-2451 180 60100 MEDICAL CTR OF AURORA THE 700 POTOMAC ST AURORA CO 80011 (303) 695-2603 20 60103 CENTURA HEALTH-AVISTA ADVENTIST HOSP 100 HEALTH PARK DR LOUISVILLE CO 80027 (303) 673-1000 60 60104 CENTURA HEALTH-ST ANTHONY NORTH HOSP 2551 W 84TH AVENUE WESTMINSTER CO 80031 (303) 426-2151 150 60107 NATL JEWISH MEDICAL & RESEARCH CTR 1400 JACKSON ST DENVER CO 80206 (303) 398-1031 150 61300 WEISBROD MEMORIAL CTY HOSP - CAH 1208 LUTHER ST EADS CO 81036 (719) 438-5401 300 61301 RIO GRANDE HOSPITAL - CAH 1280 GRAND AVE DEL NORTE CO 81132 (719) 657-2510 520 61302 FAMILY HEALTH WEST HOSPITAL - CAH 228 NORTH CHERRY ST PO BOX 130 FRUITA CO 81521 (970) 858-9871 380 61303 EAST MORGAN COUNTY HOSPITAL - CAH 2400 W BRUSH BRUSH CO 80723 (970) 842-5151 430 61304 HAXTUN HOSPITAL DISTRICT - CAH 235 W FLETCHER ST HAXTUN CO 80731 (970) 774-6123 470 61305 MELISSA MEMORIAL HOSPITAL - CAH 505 S BAXTER ST HOLYOKE CO 80734 (970) 854-2241 470 61306 LINCOLN COMM HOSP - CAH 111 6TH ST HUGO CO 80821 (719) 743-2421 360 61307 RANGELY DISTRICT HOSP - CAH 511 S WHITE AVE RANGELY CO 81648 (970) 675-5011 510 61308 CONEJOS COUNTY HOSPITAL - CAH 19021 STATE HWY 285 LA JARA CO 81140 (719) 274-5121 100 61309 WRAY COMM DIST HOSPITAL - CAH 1017 W 7TH BOX 65 WRAY CO 80758 (970) 332-4811 620 61310 SEDGWICK COUNTY MEM HOSP - CAH 900 CEDAR ST JULESBURG CO 80737 (719) 523-4501 40 61311 SOUTHEAST COLORADO HOSPITAL - CAH 373 E 10TH AVE SPRINGFIELD CO 81073 (719) 523-4501 40 61312 ESTES PARK MEDICAL CENTER - CAH 555 PROSPECT ESTES PARK CO 80517 (970) 586-9513 340 61313 KIT CARSON COUNTY MEMORIAL HOSP-CAH 286 16TH STREET BURLINGTON CO 80807 (719) 346-5311 310 61314 MEMORIAL HOSPITAL, THE - CAH 785 RUSSELL ST CRAIG CO 81625 (970) 824-9411 400 61315 YUMA DISTRICT HOSPITAL - CAH 910 S MAIN ST YUMA CO 80759 (970) 848-5405 620 61316 SPANISH PEAKS REG HLTH CTR - CAH 23500 US HWY 160 WALSENBURG CO 81089 (719) 738-4500 270 61990 WIDE HORIZON 8900 WEST 38TH STREET LAKEWOOD CO 80033 (303) 424-4445 0 62008 CMHIP - GENERAL HOSPITAL 1600 WEST 24TH ST PUEBLO CO 81003 (719) 546-4745 500 62009 KINDRED HOSPITAL DENVER 1920 HIGH ST DENVER CO 80218 (303) 331-5225 150 62011 CRAIG HOSPITAL 3425 S CLARKSON ST ENGLEWOOD CO 80110 (303) 789-8800 20 62012 LIFECARE HOSPITALS OF DENVER 1601 LOWELL BLVD DENVER CO 80204 (303) 899-5177 150 62013 SCCI HOSPITAL - AURORA 700 POTOMAC ST AURORA CO 80012 (720) 857-8333 150 62014 MEDIPLEX SPECIALTY HOSPITAL REHAB 8451 PEARL ST THORNTON CO 80229 (303) 288-3000 0 62015 SELECT SPECIALTY HOSPITAL 1719 E 19TH AVE 5TH FLOOR DENVER CO 80218 (303) 563-3700 150 62016 SEMPERCARE HOSPITAL OF COLO SPRINGS 825 PIKES PEAK AVE COLORADO SPRINGS CO 80903 (719) 667-1009 200 63027 SPALDING REHABILITATION HOSP 900 POTOMAC ST AURORA CO 80011 (303) 367-1166 150 63030 HEALTHSOUTH REHAB HOSP OF COLO SPGS 325 PARKSIDE DR COLORADO SPRINGS CO 80910 (719) 630-8000 200 63301 CHILDRENS HOSPITAL ASSOCIATION THE 1056 E 19TH AVE DENVER CO 80218 (303) 861-8888 150 64001 CMHIP - PSYCHIATRIC HOSPITAL 1600 WEST 24TH ST PUEBLO CO 81003 (719) 546-4147 500 64003 COLORADO MENTAL HLTH CTR AT FT LOGAN 3520 W OXFORD AVE DENVER CO 80236 (303) 762-4331 150 64007 CENTENNIAL PEAKS HOSPITAL 2255 SO 88TH ST LOUISVILLE CO 80027 (303) 673-9990 60 64009 CEDAR SPRINGS BEH HLTH SYSTEM INC 2135 SOUTHGATE RD PO BOX 640 COLORADO SPRINGS CO 80906 (719) 633-4114 200 64011 DEVEREUX CLEO WALLACE 8405 CHURCH RANCH BLVD WESTMINSTER CO 80020 (303) 466-7391 0 64018 SUNHEALTH SPECIALTY HOSP-PSYCH SRVCS 8451 PEARL ST THORNTON CO 80229 (303) 288-3000 0 64022 CMHIP - FORENSIC HOSPITAL 1600 WEST 24TH STREET PUEBLO CO 81003 (719) 546-4147 500 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 22 Provider ID Hospital Name Address City State ZIP Telephone County 70001 HOSPITAL OF ST RAPHAEL 1450 CHAPEL ST NEW HAVEN CT 6511 (203) 789-3000 40 70002 ST FRANCIS HOSPITAL & MEDICAL CENTER 114 WOODLAND STREET HARTFORD CT 6105 (860) 714-4000 10 70003 DAY KIMBALL HOSPITAL 320 POMFRET STREET PUTNAM CT 6260 (203) 928-6541 70 70004 SHARON HOSPITAL 50 HOSPITAL HILL ROAD, PO BOX 789 SHARON CT 6069 (860) 364-4141 20 70005 WATERBURY HOSPITAL HEALTH CENTER 64 ROBBINS ST WATERBURY CT 6721 (203) 573-6000 40 70006 STAMFORD HOSPITAL SHELBURNE RD & WEST BROAD ST STAMFORD CT 6904 (203) 325-7000 0 70007 LAWRENCE & MEMORIAL HOSPITAL 365 MONTAUK AVE NEW LONDON CT 6320 (860) 441-0711 50 70008 JOHNSON MEMORIAL HOSPITAL 201 CHESTNUT HILL RD STAFFORD SPRINGS CT 6076 (860) 684-4251 60 70009 BRADLEY MEMORIAL HOSPITAL & HEALTH CTR 81 MERIDEN AVENUE SOUTHINGTON CT 6489 (860) 276-5000 10 70010 BRIDGEPORT HOSPITAL 267 GRANT STREET BRIDGEPORT CT 6610 (203) 384-3000 10 70011 CHARLOTTE HUNGERFORD HOSPITAL 540 LITCHFIELD ST TORRINGTON CT 6790 (860) 496-6666 20 70012 ROCKVILLE GENERAL HOSPITAL 31 UNION ST ROCKVILLE CT 6066 (860) 872-5160 60 70015 NEW MILFORD HOSPITAL 21 ELM ST NEW MILFORD CT 6776 (860) 355-2611 20 70016 ST MARYS HOSPITAL 56 FRANKLIN ST WATERBURY CT 6706 (203) 574-6000 40 70017 MIDSTATE MEDICAL CENTER 435 LEWIS AVE MERIDEN CT 6450 (203) 694-8200 40 70018 GREENWICH HOSPITAL ASSOCIATION 5 PERRYRIDGE RD GREENWICH CT 6830 (203) 863-3000 0 70019 MILFORD HOSPITAL, INC 2047 BRIDGEPORT AVE MILFORD CT 6460 (203) 976-4230 40 70020 MIDDLESEX HOSPITAL 28 CRESCENT ST MIDDLETOWN CT 6457 (860) 344-6000 30 70021 WINDHAM COMM MEM HOSP & HATCH HOSP 112 MANSFIELD AVE WILLIMANTIC CT 6226 (860) 456-9116 70 70022 YALE-NEW HAVEN HOSPITAL 20 YORK ST NEW HAVEN CT 6504 (203) 688-4242 40 70024 WILLIAM W BACKUS HOSPITAL 326 WASHINGTON ST NORWICH CT 6360 (860) 889-8331 50 70025 HARTFORD HOSPITAL 80 SEYMOUR ST HARTFORD CT 6102 (860) 545-5555 10 70027 MANCHESTER MEMORIAL HOSPITAL 71 HAYNES ST MANCHESTER CT 6040 (860) 647-4780 10 70028 ST VINCENT'S MEDICAL CENTER 2800 MAIN ST BRIDGEPORT CT 6606 (203) 576-6000 0 70029 BRISTOL HOSPITAL BREWSTER RD BRISTOL CT 6010 (860) 585-3222 10 70031 GRIFFIN HOSPITAL 130 DIVISION ST DERBY CT 6418 (203) 735-7421 40 70033 DANBURY HOSPITAL 24 HOSPITAL AVE DANBURY CT 6810 (203) 797-7403 0 70034 NORWALK HOSPITAL ASSOCIATION 24 STEVENS STREET NORWALK CT 6856 (203) 852-2000 0 70035 NEW BRITAIN GENERAL HOSPITAL 100 GRAND STREET NEW BRITAIN CT 6050 (203) 224-5011 10 70036 JOHN DEMPSEY HOSPITAL 263 FARMINGTON AVE FARMINGTON CT 6032 (860) 679-1145 10 70038 CONNECTICUT HOSPICE INC,THE 100 DOUBLE BEACH ROAD BRANFORD CT 6405 (203) 481-6231 40 70039 MASONIC HOME AND HOSPITAL 22 MASONIC AVE WALLINGFORD CT 6492 (203) 679-5900 40 72003 GAYLORD HOSPITAL INC GAYLORD FARM RD WALLINGFORD CT 6492 (203) 284-2800 40 72004 HOSPITAL FOR SPECIAL CARE 2150 CORBIN AVE NEW BRITAIN CT 6050 (860) 223-2761 10 72006 DEPARTMENT OF VETERANS' AFFAIRS 287 WEST ST ROCKY HILL CT 6067 (203) 529-2571 10 72008 HEBREW HOME AND HOSPITAL, INC 1 ABRAHMS BLVD WEST HARTFORD CT 6117 (860) 523-3800 10 73025 REHABILITATION HOSPITAL OF CT, INC 490 BLUE HILLS AVENUE HARTFORD CT 6112 (860) 714-3500 10 73300 CONNECTICUT CHILDRENS MEDICAL CENTER 282 WASHINGTON STREET HARTFORD CT 6106 (860) 545-9000 10 74000 HALL-BROOKE HOSPITAL 47 LONG LOTS ROAD BOX 31 WESTPORT CT 6880 (203) 227-1251 0 74003 CONNECTICUT VALLEY HOSP SILVER ST MIDDLETOWN CT 6457 (203) 344-2666 30 74007 SAINT FRANCIS CARE BEHAVIORAL HEALTH 25 MARLBOROUGH STREET PORTLAND CT 6480 (860) 342-0480 30 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 23 Provider ID Hospital Name Address City State ZIP Telephone County 74008 NATCHAUG HOSPITAL 189 STORRS RD MANSFIELD CENTER CT 6250 (860) 456-1311 70 74009 CEDARCREST REGIONAL HOSPITAL 525 RUSSELL ROAD NEWINGTON CT 6111 (860) 666-7603 10 74011 CONNECTICUT MENTAL HEALTH CENTER 34 PARK ST NEW HAVEN CT 6508 (203) 974-3000 40 74012 SOUTHWEST CONNECTICUT MENTAL HEALTH 1635 CENTRAL AVE BRIDGEPORT CT 6610 (203) 579-6646 0 74014 SILVER HILL HOSPITAL INC 208 VALLEY ROAD NEW CANAAN CT 6840 (203) 966-3561 0 80001 MEDICAL CNTR OF DELAWARE PO BOX 1668 WILMINGTON DE 19899 (302) 428-2571 10 80003 ST FRANCIS HOSPITAL INC 7TH & CLAYTON STS PO BOX 2500 WILMINGTON DE 19805 (302) 421-4100 10 80004 BAYHEALTH MEDICAL CENTER 640 S STATE STREET DOVER DE 19901 (302) 734-4701 0 80006 NANTICOKE MEMORIAL HOSPITAL INC 801 MIDDLEFORD RD SEAFORD DE 19973 (302) 629-6611 20 80007 BEEBE MEDICAL CENTER 424 SAVANNAH RD LEWES DE 19958 (302) 645-3537 20 82000 SELECT SPECIALTY HOSPITAL WILMINGTON 7 CLAYTON STREETS WILMINGTON DE 19801 (314) 725-0112 10 83025 EUGENE DUPONT MEMORIAL DIVISION HOSP 3506 KENNETT PIKE WILMINGTON DE 19807 (302) 428-2003 10 83300 ALFRED I DUPONT INSTITUTE 1600 ROCKLAND RD PO BOX 269 WILMINGTON DE 19899 (302) 651-4000 10 84001 DELAWARE PSYCHIATRIC CENTER 1901 N DUPONT HIGHWAY NEW CASTLE DE 19720 (302) 255-2700 10 84002 ROCKFORD CENTER 100 ROCKFORD DRIVE NEWARK DE 19714 (302) 996-5480 10 84003 MEADOWWOOD BEHAVIORAL HEALTH SYSTEM 575 SOUTH DUPONT HIGHWAY NEW CASTLE DE 19720 (302) 995-8521 10 90001 GEORGE WASHINGTON UNIV HOSPITAL 901 23RD ST NW WASHINGTON DC 20037 (202) 716-4605 0 90003 HOWARD UNIVERSITY HOSPITAL 2041 GEORGIA AVE NW WASHINGTON DC 20060 (202) 745-6100 0 90004 GEORGETOWN UNIVERSITY HOSPITAL 3800 RESERVIOR RD WASHINGTON DC 20007 (202) 784-3000 0 90005 SIBLEY MEMORIAL HOSPITAL 5255 LOUGHBORO RD NW WASHINGTON DC 20016 (202) 537-4680 0 90006 PROVIDENCE HOSPITAL 1150 VARNUM ST NE WASHINGTON DC 20017 (202) 269-7000 0 90008 GREATER SOUTHEAST COMMUNITY HOSPITAL 1310 SOUTHERN AVE SE WASHINGTON DC 20032 (202) 574-6000 0 90011 WASHINGTON HOSPITAL CENTER 110 IRVING ST NW WASHINGTON DC 20010 (202) 541-6101 0 92002 MEDLINK HOSPITAL OF CAPITOL HILL 700 CONSTITUTION AVENUE N E WASHINGTON DC 20002 (202) 675-0400 0 92003 HADLEY MEMORIAL HOSPITAL 4601 MARTIN LUTHER KING JR AVENUE WASHINGTON DC 20032 (202) 574-5770 0 93025 NATIONAL REHAB HOSP 102 IRVING ST NW WASHINGTON DC 20010 (202) 877-1000 0 93300 CHILDREN'S HOSPITAL NMC 111 MICHIGAN AVE, NW WASHINGTON DC 20010 (202) 884-5000 0 94001 ST ELIZABETHS HOSPITAL 2700 MARTIN LUTHER KING JR AVE SE WASHINGTON DC 20032 (202) 645-5460 0 94004 PSYCHIATRIC INSTITUTE OF WASHINGTON DC 4228 WISCONSIN AVENUE, NW WASHINGTON DC 20007 (202) 885-5600 0 94005 RIVERSIDE HOSPITAL 4460 MCARTHUR BLVD N W WASHINGTON DC 20007 (202) 333-9355 0 100001 SHANDS JACKSONVILLE MEDICAL CENTER 655 W 8TH ST JACKSONVILLE FL 32209 (904) 350-6899 150 100002 BETHESDA MEMORIAL HOSPITAL 2815 SOUTH SEACREST BLVD BOYNTON BEACH FL 33435 (407) 737-7733 490 100004 MADISON COUNTY MEMORIAL HOSPITAL 201 E MARION ST MADISON FL 32340 (850) 973-2271 390 100006 ORLANDO REGIONAL MEDICAL CENTER 1414 S KUHL AVE ORLANDO FL 32806 (305) 841-5111 470 100007 FLORIDA HOSPITAL 601 E ROLLINS AVE ORLANDO FL 32803 (407) 896-6611 470 100008 BAPTIST HOSPITAL OF MIAMI INC 8900 N KENDALL DR MIAMI FL 33176 (305) 596-1960 120 100009 CEDARS MEDICAL CENTER INC 1400 NW 12TH AVE MIAMI FL 33136 (305) 325-4515 120 100012 LEE MEMORIAL HOSPITAL BOX 2218 FORT MYERS FL 33902 (813) 332-1111 350 100014 BERT FISH MEDICAL CENTER 401 PALMETTO ST NEW SMYRNA BEACH FL 32168 (904) 424-4102 630 100015 SUN COAST HOSPITAL 1099 CITRUS TOWER BLVD CLERMONT FL 34711 (813) 581-9474 510 100017 HALIFAX MEDICAL CENTER 303 N CLYDE MORRIS BOULEVARD DAYTONA BEACH FL 32115 (904) 254-4000 630 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 24 Provider ID Hospital Name Address City State ZIP Telephone County 100018 NAPLES COMMUNITY HOSPITAL INC 350 SEVENTH ST NORTH NAPLES FL 33940 (813) 262-3131 100 100019 HOLMES REGIONAL MEDICAL CENTER 1350 S HICKORY ST MELBOURNE FL 32901 (407) 727-7000 40 100020 HEALTHSOUTH DOCTORS HOSPITAL 5000 UNIVERSITY DRIVE CORAL GABLES FL 33114 (305) 666-2111 120 100022 JACKSON MEMORIAL HOSPITAL 1611 NW 12 AVE MIAMI FL 33136 (305) 549-6754 120 100023 CITRUS MEMORIAL HOSPITAL 502 HIGHLAND BLVD INVERNESS FL 34452 (850) 386-2242 210 100024 FISHERMENS HOSPITAL 3301 OVERSEAS HWY BOX 500068 MARATHON FL 33050 (305) 743-5533 430 100025 SACRED HEART HOSPITAL 5151 N 9 AVE PENSACOLA FL 32504 (904) 476-7851 160 100026 BAY MEDICAL CENTER 615 N BONITA AVE PANAMA CITY FL 32401 (904) 769-1511 20 100027 GULF PINES HOSPITAL 102 20TH ST PORT SAINT JOE FL 32456 (850) 227-1121 220 100028 PARRISH MEDICAL CENTER 951 WASHINGTON AVE TITUSVILLE FL 32796 (407) 268-6111 40 100029 NORTH SHORE MEDICAL CENTER 1100 NW 95TH ST MIAMI FL 33150 (305) 835-6000 120 100030 HEALTH CENTRAL 1000 W COLONIAL DR OCOEE FL 34761 (407) 296-1801 470 100032 BAYFRONT MEDICAL CENTER INC 701 SIXTH ST S SAINT PETERSBURG FL 33701 (813) 893-6801 510 100034 MOUNT SINAI HOSPITAL 4300 ALTON RD MIAMI BEACH FL 33140 (305) 674-2121 120 100035 MANATEE MEMORIAL HOSPITAL 206 2 ST E BRADENTON FL 34208 (813) 746-5111 400 100038 MEMORIAL HOSPITAL 3501 JOHNSON ST HOLLYWOOD FL 33021 (305) 987-2000 50 100039 BROWARD GENERAL MEDICAL CENTER 1600 S ANDREWS AVE FORT LAUDERDALE FL 33316 (305) 355-4400 50 100040 ST VINCENTS MEDICAL CENTER INC 1800 BARRS ST JACKSONVILLE FL 32204 (904) 387-7300 150 100043 MEASE HOSPITAL DUNEDIN 601 MAIN STREET DUNEDIN FL 34697 (813) 734-6365 510 100044 MARTIN MEMORIAL MEDICAL CENTER BOX 9010 STUART FL 34995 (407) 287-5200 420 100045 FLORIDA HOSPITAL DELAND 701 W PLYMOUTH AV DE LAND FL 32720 (904) 734-3320 630 100046 EAST PASCO MEDICAL CENTER 7050 GALL BLVD ZEPHYRHILLS FL 33541 (813) 788-0411 500 100047 CHARLOTTE REGIONAL MEDICAL CENTER 809 E MARION AVE PUNTA GORDA FL 33950 (813) 637-2519 70 100048 JAY HOSPITAL 221 S ALABAMA ST JAY FL 32565 (850) 675-8022 560 100049 HIGHLANDS REGIONAL MEDICAL CENTER 3600 S HIGHLANDS AVE DRAWER 2066 SEBRING FL 33870 (813) 385-6101 270 100050 PALM SPRINGS GENERAL HOSPITAL 1475 W 49 ST HIALEAH FL 33012 (305) 558-2500 120 100051 SOUTH LAKE HOSPITAL 1099 CITRUS TOWER BLVD CLERMONT FL 34711 (904) 394-4071 60 100052 WINTER HAVEN HOSPITAL 200 AVE F NE WINTER HAVEN FL 33880 (813) 293-1121 520 100053 HIALEAH HOSPITAL 651 E 25 ST HIALEAH FL 33013 (305) 693-6300 120 100054 TWIN CITIES HOSPITAL 2190 HIGHWAY 85 NORTH NICEVILLE FL 32578 (904) 678-4131 450 100055 HELEN ELLIS MEMORIAL HOSPITAL 1395 S PINELLAS AVE TARPON SPRINGS FL 34689 (813) 942-5000 510 100057 FLORIDA HOSPITAL/WATERMAN 201 N EUSTIS ST EUSTIS FL 32727 (352) 589-3333 340 100061 MERCY HOSPITAL INC 3663 S MIAMI AVE MIAMI FL 33133 (305) 285-2121 120 100062 MUNROE REGIONAL MEDICAL CENTER 131 SW 15TH ST OCALA FL 34471 (904) 351-7325 410 100063 NORTH BAY HOSPITAL 6600 MADISON STREET NEW PORT RICHEY FL 34652 (727) 842-8468 500 100067 ST ANTHONYS HOSPITAL 1200 7TH AVENUE NORTH SAINT PETERSBURG FL 33705 (813) 825-1100 510 100068 MEMORIAL HOSPITAL ORMOND PENINSULA 264 S ATLANTIC AVE ORMOND BEACH FL 32176 (904) 672-4200 630 100069 UNIVERSITY COMM HOSP AT CARROLLWOOD 7171 N DALE MABRY HWY TAMPA FL 33614 (813) 932-2222 280 100070 BON SECOURS VENICE HOSPITAL 540 THE RIALTO VENICE FL 34285 (941) 485-7711 570 100071 BROOKSVILLE REGIONAL HOSPITAL 55 PONCE DE LEON BLVD BOX 37 BROOKSVILLE FL 34605 (904) 796-5111 260 100072 FLORIDA HOSPITAL FISH MEMORIAL 1055 SAXON BLVD ORANGE CITY FL 32763 (904) 734-2323 630 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 25 Provider ID Hospital Name Address City State ZIP Telephone County 100073 HOLY CROSS HOSPITAL 4725 N FEDERAL HIGHWAY FORT LAUDERDALE FL 33308 (305) 776-3011 50 100075 ST JOSEPHS HOSPITAL 3001 W MARTIN LUTHER KING JR BLVD TAMPA FL 33677 (813) 870-4020 280 100076 PAN AMERICAN HOSPITAL 5959 NW 7 ST MIAMI FL 33126 (305) 264-1000 120 100077 ST JOSEPH HOSPITAL PORT CHARLOTTE 2500 HARBOR BLVD PORT CHARLOTTE FL 33952 (813) 625-4122 70 100079 UNIVERSITY OF MIAMI HOSP & CLINIC 1475 NW 12 AVE MIAMI FL 33136 (305) 547-6418 120 100080 JFK MEDICAL CENTER 5301 S CONGRESS AVE ATLANTIS FL 33462 (407) 965-7300 490 100081 HEALTHMARK REGIONAL MEDICAL CENTER 21 COLLEGE AVE DEFUNIAK SPRINGS FL 32433 (904) 892-5171 650 100084 LEESBURG REGIONAL MEDICAL CENTER 600 E DIXIE AVENUE LEESBURG FL 34748 (352) 323-5001 340 100086 NORTH BROWARD MEDICAL CENTER 201 E SAMPLE RD POMPANO BEACH FL 33064 (305) 786-6950 50 100087 SARASOTA MEMORIAL HOSPITAL 1700 S TAMIAMI TRAIL SARASOTA FL 34239 (813) 953-1725 570 100088 BAPTIST MEDICAL CENTER 800 PRUDENTIAL DR JACKSONVILLE FL 32207 (904) 393-2000 150 100090 FLAGLER HOSPITAL WEST 400 HEALTH PARK BLVD SAINT AUGUSTINE FL 32084 (904) 824-8411 540 100092 WUESTHOFF MEMORIAL HOSPITAL 110 LONGWOOD AVE ROCKLEDGE FL 32955 (407) 636-2211 40 100093 BAPTIST HOSPITAL 1000 WEST MORENO STREET PENSACOLA FL 32501 (904) 434-4801 160 100098 HENDRY REGIONAL MEDICAL CENTER 500 WEST SURGARLAND HIGHWAY CLEWISTON FL 33440 (813) 983-9121 250 100102 SHANDS AT LAKE SHORE 368 NE FRANKLIN STREET LAKE CITY FL 32055 (904) 755-3200 110 100103 SHANDS AT STARKE 922 EAST CALL STREET STARKE FL 32091 (904) 964-6000 30 100105 INDIAN RIVER MEMORIAL HOSPITAL 1000 36TH ST VERO BEACH FL 32960 (407) 567-4311 300 100106 DOCTORS MEMORIAL HOSPITAL 407 E ASH ST PERRY FL 32347 (904) 584-0885 610 100107 LEHIGH REGIONAL MEDICAL CENTER 1500 LEE BLVD LEHIGH ACRES FL 33936 (813) 369-2101 350 100108 TRINITY COMMUNITY HOSPITAL 506 NW 4TH ST JASPER FL 32052 (904) 792-7200 230 100109 FLORIDA HOSPITAL HEARTLAND MEDICAL CTR 4200 SUN N LAKE BLVD SEBRING FL 33872 (813) 453-7511 270 100110 OSCEOLA REGIONAL MEDICAL CENTER 700 WEST OAK STREET KISSIMMEE FL 34742 (407) 846-2266 480 100113 SHANDS HOSP AT THE UNIVERSITY OF FL 4101 NW 89TH BLVD GAINESVILLE FL 32606 (352) 395-0040 0 100114 PARKWAY REGIONAL MEDICAL CENTER 160 NW 170TH ST NORTH MIAMI BEACH FL 33169 (305) 651-1100 120 100117 BAPTIST MEDICAL CENTER - BEACHES 1350 13TH AVE SOUTH JACKSONVILLE BEACH FL 32250 (904) 247-2905 150 100118 MEMORIAL HOSPITAL FLAGLER SW BEDS MOODY BOULVARD/RT 100 BUNNELL FL 32110 (904) 437-2211 170 100121 BARTOW MEMORIAL HOSPITAL 1239 E MAIN ST BARTOW FL 33830 (813) 533-8111 520 100122 NORTH OKALOOSA MEDICAL CENTER 151 REDSTONE AVENUE SOUTHEAST CRESTVIEW FL 32536 (904) 682-9731 450 100124 SANTA ROSA MEDICAL CENTER 6002 BERRYHILL RD MILTON FL 32570 (904) 623-9741 560 100125 HOMESTEAD HOSPITAL INC 160 NW 13TH STREET HOMESTEAD FL 33030 (305) 242-3540 120 100126 PALMS OF PASADENA HOSPITAL 1501 PASADENA AVE SOUTH SAINT PETERSBURG FL 33707 (813) 381-1000 510 100127 MORTON PLANT HOSPITAL 323 JEFFORDS ST CLEARWATER FL 33755 (813) 462-7000 210 100128 TAMPA GENERAL HOSPITAL DAVIS ISLAND P O BOX 1289 TAMPA FL 33606 (813) 251-7000 280 100130 GLADES GENERAL HOSPITAL 1201 S MAIN ST BELLE GLADE FL 33430 (561) 996-6571 490 100131 AVENTURA HOSPITAL & MEDICAL CENTER 20900 BISCAYNE BLVD AVENTURA FL 33180 (305) 932-0250 120 100132 SOUTH FLORIDA BAPTIST HOSPITAL 301 ALEXANDER ST PLANT CITY FL 33566 (813) 757-1200 280 100134 ED FRAZIER MEMORIAL HOSPITAL 159 N 3RD ST MACCLENNY FL 32063 (904) 259-3151 10 100135 TALLAHASSEE MEMORIAL HEALTHCARE MAGNOLIA DR & MICCOSUKEE RD TALLAHASSEE FL 32308 (904) 681-5330 360 100137 HEART OF FLORIDA REGIONAL MED CENTER 1615 US HIGHWAY 27 NORTH DAVENPORT FL 33837 (813) 422-4971 520 100139 NATURE COAST HOSPITAL INC SWB 125 SW 7TH ST WILLISTON FL 32696 (352) 528-2801 370 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 26 Provider ID Hospital Name Address City State ZIP Telephone County 100140 BAPTIST MEDICAL CENTER - NASSAU 1250 S 18TH ST FERNANDINA BEACH FL 32034 (904) 261-3627 440 100142 JACKSON COUNTY HOSPITAL 4250 HOSPITAL DRIVE MARIANNA FL 32446 (850) 526-2200 310 100147 NORTHWEST FLORIDA COMMUNITY HOSPITAL 1360 BRICKYARD RD CHIPLEY FL 32428 (850) 638-1610 660 100150 LOWER KEYS MEDICAL CENTER 5900 JUNIOR COLLEGE ROAD KEY WEST FL 33040 (305) 294-9200 430 100151 ST LUKES HOSPITAL 4201 BELFORD RD JACKSONVILLE FL 32216 (904) 296-3700 150 100154 SOUTH MIAMI HOSPITAL INC 6200 SW 73 ST MIAMI FL 33143 (305) 661-4611 120 100156 LAKE CITY MEDICAL CENTER 1701 W DUVAL ST LAKE CITY FL 32055 (904) 752-2922 110 100157 LAKELAND REGIONAL MEDICAL CENTER 1400 LAKELAND HILLS BLVD LAKELAND FL 33802 (813) 687-1100 520 100160 MARINERS HOSPITAL 91500 OVERSEAS HIGHWAY TAVERNIER FL 33070 (305) 852-4418 430 100161 CENTRAL FLORIDA REGIONAL HOSPITAL 1401 W SEMINOLE BLVD SANFORD FL 32771 (407) 321-4500 580 100166 DOCTORS HOSPITAL OF SARASOTA 5731 BEE RIDGE ROAD SARASOTA FL 34239 (813) 366-1411 570 100167 PLANTATION GENERAL HOSPITAL 401 NW 42 AVE PLANTATION FL 33317 (305) 587-5010 50 100168 BOCA RATON COMMUNITY HOSPITAL INC 800 MEADOWS RD BOCA RATON FL 33432 (407) 395-7100 490 100172 SOUTH SHORE HOSPITAL & MEDICAL CENTER 630 ALTON RD MIAMI BEACH FL 33139 (305) 672-2100 120 100173 UNIVERSITY COMMUNITY HOSPITAL 3100 E FLETCHER AVE TAMPA FL 33612 (813) 971-6000 280 100175 DESOTO MEMORIAL HOSPITAL N ROBERTS AVE ARCADIA FL 34265 (813) 494-3535 130 100176 PALM BEACH GARDENS MEDICAL CENTER 3360 BURNS RD PALM BEACH GARDENSFL 33410 (407) 622-1411 490 100177 CAPE CANAVERAL HOSPITAL 701 W COCOA BEACH CAUSEWAY COCOA BEACH FL 32932 (407) 799-7111 40 100179 MEMORIAL HOSPITAL JACKSONVILLE 3625 UNIVERSITY BLVD SOUTH JACKSONVILLE FL 32216 (904) 399-6111 150 100180 ST PETERSBURG MEDICAL CENTER 6500 38 AVE N SAINT PETERSBURG FL 33710 (813) 384-1414 510 100181 LARKIN COMMUNITY HOSPITAL 7031 SW 62 AVE SOUTH MIAMI FL 33143 (305) 284-7500 120 100183 CORAL GABLES HOSPITAL 3100 DOUGLAS RD CORAL GABLES FL 33134 (305) 445-8461 120 100187 PALMETTO GENERAL HOSPITAL 2001 W 68TH ST HIALEAH FL 33016 (305) 823-5000 120 100189 NORTHWEST MEDICAL CENTER 5801 COLONIAL DRIVE MARGATE FL 33063 (305) 974-0400 50 100191 COMMUNITY HOSPITAL 5637 MARINE PKWY NEW PORT RICHEY FL 34656 (813) 848-1733 500 100200 IMPERIAL POINT MEDICAL CENTER 6401 NORTH FEDERAL HIGHWAY FORT LAUDERDALE FL 33308 (305) 776-8500 50 100204 NORTH FLORIDA REGIONAL MEDICAL CENTER 6500 NEWBERRY ROAD GAINESVILLE FL 32614 (904) 333-4100 0 100206 MEMORIAL HOSPITAL OF TAMPA 2901 SWANN AVE TAMPA FL 33609 (813) 873-6479 280 100209 KENDALL MEDICAL CENTER 11750 BIRD DRIVE MIAMI FL 33175 (305) 227-5500 120 100210 FLORIDA MEDICAL CENTER 5000 W OAKLAND PARK BLVD FORT LAUDERDALE FL 33313 (305) 735-6000 50 100211 PASCO REGIONAL MEDICAL CENTER 13100 FT KING ROAD DADE CITY FL 33525 (352) 567-6726 500 100212 OCALA REGIONAL MEDICAL CENTER 1431 SW FIRST STREET OCALA FL 32671 (352) 401-1000 0 100213 BLAKE MEDICAL CENTER 2020 59TH ST W BRADENTON FL 34209 (813) 792-6611 400 100217 SEBASTIAN RIVER MEDICAL CENTER 13695 U S HIGHWAY 1 SEBASTIAN FL 32958 (407) 589-3186 300 100220 SOUTHWEST FLORIDA REG MED CENTER 2727 WINKLER AVENUE FORT MYERS FL 33901 (813) 939-1147 350 100223 FORT WALTON BEACH MEDICAL CENTER 1000 MAR WALT DRIVE FORT WALTON BEACH FL 32548 (904) 862-1111 450 100224 UNIVERSITY HOSPITAL & MED CEN 7201 N UNIVERSITY DR TAMARAC FL 33321 (305) 721-2200 50 100225 HOLLYWOOD MEDICAL CENTER 3600 WASHINGTON ST HOLLYWOOD FL 33021 (305) 966-4500 50 100226 ORANGE PARK MEDICAL CENTER INC 2001 KINGSLEY AVE ORANGE PARK FL 32073 (904) 276-8500 90 100228 WESTSIDE REGIONAL MEDICAL CEN 8201 W BROWARD BLVD PLANTATION FL 33324 (305) 473-6600 50 100230 MEMORIAL HOSPITAL PEMBROKE 2301 N UNIVERSITY DRIVE PEMBROKE PINES FL 33024 (305) 962-9650 50 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 27 Provider ID Hospital Name Address City State ZIP Telephone County 100231 WEST FLORIDA HOSPITAL 8383 N DAVIS HIGHWAY PENSACOLA FL 32514 (904) 494-4000 160 100232 PUTNAM COMMUNITY MEDICAL CENTER HIGHWAY 20 W DRAWER 778 PALATKA FL 32177 (904) 328-5711 530 100234 COLUMBIA HOSPITAL 2201 45 ST WEST PALM BEACH FL 33407 (561) 842-6141 490 100236 FAWCETT MEMORIAL HOSPITAL 101 NW OLEAN BLVD PORT CHARLOTTE FL 33952 (813) 629-1181 70 100237 NORTH RIDGE MEDICAL CENTER 5757 N DIXIE HWY FORT LAUDERDALE FL 33334 (305) 776-6000 50 100238 NORTHSIDE HOSPITAL 6000 49TH STREET N SAINT PETERSBURG FL 33709 (813) 521-5000 510 100239 EDWARD WHITE HOSPITAL 2323 NINETH AVE N SAINT PETERSBURG FL 33733 (813) 323-1111 510 100240 ANNE BATES LEACH EYE HOSPITAL 900 NW 17TH ST MIAMI FL 33136 (305) 326-6000 120 100242 GULF COAST MEDICAL CENTER 449 W 23RD ST PANAMA CITY FL 32405 (904) 769-8341 20 100243 BRANDON REGIONAL HOSPITAL 119 OAKFIELD DR BRANDON FL 33511 (813) 681-5551 280 100244 CAPE CORAL HOSPITAL 636 DEL PRADO BLVD CAPE CORAL FL 33904 (941) 574-2323 350 100246 LAWNWOOD REGIONAL MEDICAL CENTER 1860 N LAWNWOOD CIRCLE FORT PIERCE FL 34950 (407) 468-4500 550 100248 LARGO MEDICAL CENTER 201 14TH ST SW LARGO FL 34641 (813) 586-1411 510 100249 SEVEN RIVERS COMMUNITY HOSPITAL 6201 N SUNCOAST BLVD CRYSTAL RIVER FL 34428 (904) 795-6560 80 100252 RAULERSON HOSPITAL 1796 HIGHWAY 441 N OKEECHOBEE FL 34973 (813) 763-2151 460 100253 JUPITER MEDICAL CENTER INC 1210 S OLD DIXIE HIGHWAY JUPITER FL 33458 (407) 747-2234 490 100254 TALLAHASSEE COMMUNITY HOSPITAL 2626 CAPITAL MEDICAL BLVD TALLAHASSEE FL 32308 (904) 656-5056 360 100255 TOWN & COUNTRY HOSPITAL 6001 WEBB RD TAMPA FL 33615 (813) 882-7159 280 100256 REGIONAL MEDICAL CENTER BAYONET POINT 14000 FIVAY ROAD HUDSON FL 34667 (813) 863-2411 500 100258 DELRAY MEDICAL HOSPITAL 5352 LINTON BLVD DELRAY BEACH FL 33445 (407) 495-3100 490 100259 SOUTH BAY HOSPITAL 4016 STATE ROAD 674 SUN CITY CENTER FL 33570 (813) 634-3301 280 100260 SAINT LUCIE MEDICAL CENTER 1800 SE TIFFANY AVENUE PORT SAINT LUCIE FL 34952 (407) 335-4000 550 100264 OAK HILL HOSPITAL 11375 CORTEZ BLVD BOX 5300 SPRING HILL FL 34606 (352) 596-6632 260 100265 MEASE HOSPITAL COUNTRYSIDE 3231 MCMULLEN BOOTH RD SAFETY HARBOR FL 34695 (813) 725-6103 510 100266 GULF BREEZE HOSPITAL 1110 GULF BREEZE PARKWAY GULF BREEZE FL 32561 (904) 934-2000 560 100267 ENGLEWOOD COMMUNITY HOSPITAL 700 MEDICAL BLVD ENGLEWOOD FL 34295 (813) 475-6571 570 100268 WEST BOCA MEDICAL CENTER 21644 STATE RD 7 BOCA RATON FL 33428 (407) 488-8000 490 100269 PALMS WEST HOSPITAL 13001 SOUTHERN BLVD LOXAHATCHEE FL 33470 (561) 798-3300 490 100271 H LEE MOFFITT CAN CTR & RESCH INST INC 12902 MAGNOLIA DR TAMPA FL 33612 (813) 972-4673 280 100275 WELLINGTON REGIONAL MEDICAL CENTER 10101 FOREST HILL BLVD WEST PALM BEACH FL 33414 (407) 798-8500 490 100276 CORAL SPRINGS MEDICAL CENTER 3000 CORAL HILLS DRIVE CORAL SPRINGS FL 33065 (305) 344-3000 50 100277 DOUGLAS GARDENS HOSPITAL 5200 NE 2ND AVE MIAMI FL 33137 (305) 751-8626 120 100279 GULF COAST HOSPITAL 13681 DOCTORS WAY FORT MYERS FL 33912 (813) 768-5000 350 100280 SPRING HILL REGIONAL HOSPITAL 1046 QUALITY DRIVE SPRING HILL FL 34609 (352) 688-8200 260 100281 MEMORIAL HOSPITAL WEST 703 N FLAMINGO ROAD PEMBROKE PINES FL 33028 (305) 436-5000 50 100284 WESTCHESTER GENERAL HOSPITAL 2500 SW 75TH AVENUE MIAMI FL 33165 (305) 264-5252 120 100286 CLEVELAND CLINIC FLORIDA HOSPITAL 6101 PINE RIDGE ROAD NAPLES FL 34119 (941) 348-4000 100 100287 GOOD SAMARITAN MEDICAL CENTER 1309 NORTH FLAGLER DRIVE WEST PALM BEACH FL 33401 (561) 655-5511 490 100288 SAINT MARY'S MEDICAL CENTER 901 46TH STREET WEST PALM BEACH FL 33407 (561) 844-6300 120 100289 CLEVELAND CLINIC HOSPITAL 3100 WESTON ROAD DAVIE FL 33331 (954) 689-5000 50 100290 VILLAGES REGIONAL HOSPITAL,THE 1451 EL CAMINO REAL THE VILLAGES FL 32159 (352) 323-5940 590 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 28 Provider ID Hospital Name Address City State ZIP Telephone County 101300 FLORIDA HOSPITAL WAUCHULA 533 WEST CARLTON STREET WAUCHULA FL 33873 (863) 773-3101 240 101301 SHANDS AT LIVE OAK 1100 SW 11TH ST LIVE OAK FL 32060 (904) 362-1413 600 101302 CAMPBELLTON-GRACEVILLE HOSPITAL 5429 COLLEGE DRIVE GRACEVILLE FL 32440 (850) 263-4431 310 101303 RAMADAN HAND INSTITUTE/LAKE BUTLER 850 EAST MAIN STREET LAKE BUTLER FL 32054 (904) 496-2323 620 101304 CALHOUN LIBERTY HOSPITAL 20370 NE BURNS AVE BLOUNTSTOWN FL 32424 (850) 674-5411 60 101305 GEORGE E WEEMS MEMORIAL HOSPITAL 135 AVENUE G APALACHICOLA FL 32320 (850) 653-8853 180 101306 GADSDEN COMMUNITY HOSPITAL US HIGHWAY 90 EAST QUINCY FL 32353 (850) 875-1100 190 101307 DOCTOR'S MEMORIAL HOSPITAL 401 EAST BYRD AVENUE BONIFAY FL 32425 (850) 547-1120 290 101990 MORNINGSIDE 9220 102ND AVENUE LARGO FL 33777 (727) 398-3808 0 101991 DAYSTAR, INC 3800 SOUTH FLAMINGO ROAD DAVIE FL 33330 (954) 473-0167 0 101992 SUMMIT,THE 700 EAST WELCH ROAD APOPKA FL 32712 (407) 880-8700 0 102000 AG HOLLEY STATE HOSP 1199 W LANTANA RD LANTANA FL 33465 (407) 582-5666 490 102007 FLORIDA STATE HOSPITAL UNIT 14 UNIT 31 BLDG 243 BOX 1000 CHATTAHOOCHEE FL 32324 (904) 663-7536 190 102008 SUNLAND COX MEDICAL CENTER 3700 WMS DRIVE MARIANNA FL 32446 (904) 482-9484 310 102009 KINDRED HOSPITAL BAY AREA TAMPA 4555 S MANHATTAN AVE TAMPA FL 33611 (813) 839-6341 280 102010 KINDRED HOSPITAL SOUTH FLORIDA 1516 E LAS OLAS BLVD FORT LAUDERDALE FL 33301 (954) 764-8900 50 102012 SPECIALITY HSOPITAL JACKSONVILLE 4901 RICHARD STREET JACKSONVILLE FL 32207 (904) 737-3120 150 102013 KINDRED HOSPITAL CENTRAL TAMPA 4801 NORTH HOWARD AVENUE TAMPA FL 33603 (813) 874-7575 280 102015 KINDRED HOSPITAL NORTH FLORIDA 801 OAK STREET GREEN COVE SPRINGSFL 32043 (904) 284-9230 90 103026 ST CATHERINES REHABILITATION HOSPITAL 1050 NE 125TH ST NORTH MIAMI FL 33161 (305) 891-8850 120 103027 ST JOHNS REHABILITATION HOSP 3075 NW 35TH AVE LAUDERDALE LAKES FL 33311 (305) 739-6233 50 103028 HEALTHSOUTH SUNRISE REHAB HOSPITAL 4399 NOB HILL RD SUNRISE FL 33351 (305) 749-0300 50 103030 PINECREST REHABILITATION HOSP 5360 LINTON BLVD DELRAY BEACH FL 33484 (561) 495-0400 490 103031 HEALTHSOUTH REHAB HOSPITAL OF SARASOTA 3251 PROCTOR RD SARASOTA FL 34231 (813) 921-8600 570 103032 HEALTHSOUTH TREASURE COAST REHAB HOSP 1600 37TH ST VERO BEACH FL 32960 (407) 778-2100 300 103033 HEALTHSOUTH REHAB HOSP OF TALLAHASSEE 1675 RIGGINS RD TALLAHASSEE FL 32308 (850) 656-4800 360 103034 HEALTHSOUTH SEA PINES HOSPITAL 101 EAST FLORIDA AVENUE MELBOURNE FL 32901 (407) 984-4600 50 103036 MEADOWBROOK REHAB HOSP OF WEST GABLES 2525 SW 75TH AVENUE MIAMI FL 33155 (305) 262-6800 120 103037 HEALTHSOUTH REHABILITATION CENTER 901 CLEARWATER LARGO RD LARGO FL 34641 (813) 586-2999 510 103038 HEALTHSOUTH REHABILITATION HOSPITAL 20601 OLD CUTLER ROAD MIAMI FL 33189 (305) 251-3800 120 103039 BROOKS REHABILITATION HOSPITAL 3599 UNIVERSITY BLVD, SOUTH JACKSONVILLE FL 32216 (904) 858-1602 150 103040 HEALTHSOUTH EMERALD COAST REHAB HOSP 1847 FLORIDA AVENUE PANAMA CITY FL 32405 (850) 914-8653 20 103300 ALL CHILDRENS HOSP 801 SIXTH ST S SAINT PETERSBURG FL 33701 (813) 898-7451 510 103301 MIAMI CHILDRENS HOSP 6125 SW 31ST ST MIAMI FL 33155 (305) 666-6511 120 104000 FLORIDA STATE HOSP UNIT 14 BOX 1000 BLDG 28 CHATTAHOOCHEE FL 32324 (904) 663-7536 190 104001 SOUTH FL STATE HOSPITAL 800 EAST CYPRESS DRIVE PEMBROKE PINES FL 33025 (305) 967-7000 50 104007 NORTHEAST FLORIDA STATE HOSPITAL HIGHWAY 121 SOUTH MACCLENNY FL 32063 (904) 259-6211 10 104008 OAKWOOD CENTER OF THE PALM BEACHES 1041 45TH ST WEST PALM BEACH FL 33407 (561) 844-9741 490 104015 HOLLYWOOD PAVILION HOSPITAL 1201 N 37 AVE HOLLYWOOD FL 33021 (954) 962-1355 50 104016 TEN BROECK HOSPITAL 6300 BEACH BLVD JACKSONVILLE FL 32216 (904) 724-9202 150 104017 WINDMOOR HEALTHCARE OF CLEARWATER 11300 US 19 NORTH CLEARWATER FL 33764 (727) 541-2646 510 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 29 Provider ID Hospital Name Address City State ZIP Telephone County 104018 LIFESTREAM BEHAVIORAL CENTER 2020 TALLY RD LEESBURG FL 34749 (352) 360-6598 340 104024 CIRCLES OF CARE INC 400 E SHERIDAN RD MELBOURNE FL 32901 (321) 984-4900 40 104026 FORT LAUDERDALE HOSPITAL 1601 EAST LAS OLAS BLVD FORT LAUDERDALE FL 33301 (954) 463-4321 50 104027 W FL COMMUNITY CARE CTR 400 STEWART ST NE MILTON FL 32570 (904) 623-4990 560 104032 GULF COAST TREATMENT CENTER 1015 MAR WALT DRIVE FORT WALTON BEACH FL 32548 (850) 863-4160 450 104036 SAVANNAS HOSPITAL 2550 SE WALTON RD PORT SAINT LUCIE FL 34952 (772) 335-0400 550 104040 MANATEE GLEN HOSPITAL 2020 26TH AVE E BOX 9478 BRADENTON FL 34208 (941) 741-3805 400 104049 SOUTHER WINDS HOSPITAL 4225 W 20 AVENUE HIALEAH FL 33012 (305) 558-9700 120 104057 SPRINGBROOK HOSPITAL 7007 GROVE RD BROOKSVILLE FL 34609 (352) 596-4306 260 104059 EASTSIDE PSYCHIATRIC HOSPITAL 2634-B CAPITAL CRCL NE PO BOX 1782 TALLAHASSEE FL 32308 (904) 487-2930 360 104063 WILLOUGH AT NAPLES,THE 9001 TAMIAMI TRAIL EAST NAPLES FL 34113 (941) 775-4500 100 104065 ATLANTIC SHORES HOSPITAL 4545 N FEDERAL HIGHWAY FORT LAUDERDALE FL 33308 (954) 771-2711 50 104067 LAKSIDE ALTERNATIVES HOSPITAL 1800 MERCY DRIVE ORLANDO FL 32808 (407) 875-3700 470 110001 HAMILTON MEDICAL CENTER 1200 MEMORIAL DRIVE DALTON GA 30720 (706) 278-2105 970 110002 UPSON REGIONAL MEDICAL CENTER 801 W GORDON ST THOMASTON GA 30286 (706) 647-8111 920 110003 SATILLA REGIONAL MEDICAL CENTER 410 DARLINGTON AV WAYCROSS GA 31501 (912) 283-3030 940 110004 HUTCHESON MEDICAL CENTER 100 GROSS CRESCENT FORT OGLETHORPE GA 30742 (706) 858-2100 200 110005 BAPTIST MEDICAL CENTER 1200 BAPTIST MEDICAL CENTER DRIVE CUMMING GA 30040 (770) 887-2355 461 110006 ST MARYS HOSPITAL OF ATHENS 1230 BAXTER ST ATHENS GA 30601 (706) 354-3033 260 110007 PHOEBE PUTNEY MEMORIAL HOSPITAL 417 THIRD AVE ALBANY GA 31703 (229) 883-1800 390 110008 NORTHSIDE HOSPITAL CHEROKEE 201 HOSPITAL RD PO BOX 906 CANTON GA 30114 (770) 479-1941 250 110010 EMORY UNIVERSITY HOSPITAL 1364 CLIFTON RD NE ATLANTA GA 30322 (404) 727-7021 370 110011 TANNER MEMORIAL CENTER 705 DIXIE ST CARROLLTON GA 30117 (770) 836-9666 190 110014 MINNIE G BOSWELL MEMORIAL HOSPITAL 1201 SILOAM RD GREENSBORO GA 30642 (706) 453-7331 520 110015 TANNER MEDICAL CENTER VILLA RICA 601 DALLAS HIGHWAY VILLA RICA GA 30180 (770) 459-3681 190 110016 WEST GEORGIA MEDICAL CENTER INC 1514 VERNON RD BOX 1567 LAGRANGE GA 30240 (706) 882-1411 910 110018 NEWTON GENERAL HOSPITAL 5126 HOSPITAL DRIVE NE COVINGTON GA 30209 (404) 786-7053 790 110020 EMORY PEACHTREE REGIONAL HOSPITAL 60 HOSPITAL ROAD NEWNAN GA 30263 (770) 304-4053 320 110023 GORDON HOSPITAL RED BUD RD & HWY 156 BOX 938 CALHOUN GA 30701 (706) 629-2895 500 110024 CANDLER HOSPITAL 5353 REYNOLDS ST SAVANNAH GA 31412 (912) 692-6000 220 110025 SOUTHEAST GEORGIA REGIONAL MEDICAL CEN 2415 PARKWOOD DRIVE BRUNSWICK GA 31520 (912) 264-6960 490 110026 ELBERT MEMORIAL HOSPITAL 4 MEDICAL DR ELBERTON GA 30635 (706) 283-3151 430 110027 COBB HEALTHCARE SYSTEMS, INC 577 FRANKLIN SPRINGS ST ROYSTON GA 30662 (706) 245-5034 462 110028 UNIVERSITY HOSPITAL 1350 WALTON WAY AUGUSTA GA 30910 (706) 722-9011 840 110029 NORTHEAST GEORGIA MEDICAL CENTER 743 SPRING ST GAINESVILLE GA 30501 (770) 535-3553 550 110030 EMORY CARTERSVILLE MEDICAL CENTER 960 JOE FRANK HARRIS PARKWAY CARTERSVILLE GA 30120 (770) 382-1530 60 110031 SPALDING REGIONAL HOSPITAL SOUTH 8TH ST BOX 136 GRIFFIN GA 30223 (770) 228-2721 860 110032 STEPHENS COUNTY HOSPITAL FALLS RD BOX 947 TOCCOA GA 30577 (706) 886-6841 861 110033 EMORY NORTHLAKE REGIONAL MEDICAL CEN 1455 MONTREAL ROAD TUCKER GA 30084 (770) 270-3000 370 110034 MEDICAL COLLEGE OF GA HOSPIT&CLINICS 1120 15TH ST AUGUSTA GA 30912 (706) 721-0211 840 110035 WELLSTAR KENNESTONE HOSPITAL 677 CHURCH STREET PO BOX 1208 MARIETTA GA 30060 (770) 426-2000 290 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 30 Provider ID Hospital Name Address City State ZIP Telephone County 110036 MEMORIAL HEALTH UNIV MED CEN,INC 4700 WATERS AV BOX 23089 SAVANNAH GA 31403 (912) 350-8515 220 110038 JOHN D ARCHBOLD MEMORIAL HOSPITAL GORDON AV & MIMOSA DR THOMASVILLE GA 31792 (229) 228-2000 890 110039 ST JOSEPH'S HOSPITAL 2260 WRIGHTSBORO RD AUGUSTA GA 30904 (706) 737-7400 840 110040 BANKS-JACKSON-COMMERCE HOSPITAL HOSPITAL RD COMMERCE GA 30529 (706) 335-1000 610 110041 HABERSHAM COUNTY MEDICAL CENTER HWY 441 BOX 37 DEMOREST GA 30535 (706) 754-2161 540 110042 WELLSTAR PAULDING HOSPITAL 600 W MEMORIAL DR DALLAS GA 30132 (770) 445-4411 810 110043 ST JOSEPHS HOSPITAL 11705 MERCY BLVD SAVANNAH GA 31419 (912) 925-4100 220 110044 SUMTER REGIONAL HOSPITAL 100 WHEATLEY DR AMERICUS GA 31709 (229) 924-6011 870 110045 BARROW COMMUNITY HOSPITAL 316 NORTH BROAD STREET WINDER GA 30680 (770) 267-3400 50 110046 WALTON MEDICAL CENTER 330 ALCOVA ST MONROE GA 30655 (770) 267-8461 930 110049 JEFF DAVIS HOSPITAL 1215 S TALLAHASSEE ST HAZLEHURST GA 31539 (912) 375-7781 612 110050 MURRAY MEDICAL CENTER 707 OLD DALTON ELLIJAY RD PO BOX 1406 CHATSWORTH GA 30705 (706) 517-2030 772 110051 UNION GENERAL HOSPITAL 214 HOSPITAL CIRCLE BLAIRSVILLE GA 30512 (706) 745-2111 913 110054 FLOYD MEDICAL CENTER 304 TURNER MCCALL BLVD P O BOX 233 ROME GA 30162 (706) 295-5500 460 110056 RABUN COUNTY MEMORIAL HOSPITAL 196 RIDGECREST CIRCLE CLAYTON GA 30525 (706) 782-4233 834 110059 HART COUNTY HOSPITAL 138 W GIBSON ST P O BOX 280 HARTWELL GA 30643 (706) 376-3921 581 110061 BROOKS COUNTY HOSPITAL 903 N COURT ST BOX 865 QUITMAN GA 31643 (229) 263-4171 120 110063 LIBERTY MEMORIAL HOSPITAL 112 E OGLETHORPE HWY BOX 232 HINESVILLE GA 31313 (912) 369-9400 680 110064 MEDICAL CENTER,THE 710 CENTER ST BOX 951 COLUMBUS GA 31901 (706) 571-1000 780 110069 HOUSTON MEDICAL CENTER 1601 WATSON BLVD WARNER ROBINS GA 31093 (478) 922-4281 600 110071 APPLING HOSPITAL 163 E TOLLISON STREET BAXLEY GA 31513 (912) 367-9841 0 110073 DORMINY MEDICAL CENTER PERRY HOUSE RD BOX 989 FITZGERALD GA 31750 (229) 423-5431 70 110074 ATHENS REGIONAL MEDICAL CENTER 1199 PRINCE AV ATHENS GA 30612 (706) 354-3334 260 110075 EAST GEORGIA REGIONAL MEDICAL CENTER 1499 FAIR ROAD STATESBORO GA 30458 (912) 764-6671 140 110076 DEKALB MEDICAL CENTER 2701 N DECATUR RD DECATUR GA 30033 (404) 501-1000 370 110078 CRAWFORD LONG HOSPITAL 550 PEACHTREE ST NE ATLANTA GA 30366 (404) 892-4411 470 110079 GRADY MEMORIAL HOSPITAL 80 JESSE HILL, JR DRIVE SE ATLANTA GA 30303 (404) 589-4252 470 110080 SOUTHWEST HOSPITAL AND MEDICAL CENTER 501 FAIRBURN ROAD SW ATLANTA GA 30331 (404) 699-1111 470 110082 ST JOSEPHS HOSPITAL OF ATLANTA 5665 PEACHTREE DUNWOODY RD ATLANTA GA 30342 (404) 851-7001 470 110083 PIEDMONT HOSPITAL 1968 PEACHTREE RD NW ATLANTA GA 30309 (404) 350-2222 470 110086 WASHINGTON CTY REGIONAL MEDICAL CTR 610 SPARTA RD SANDERSVILLE GA 31082 (478) 552-3901 750 110087 GWINNETT HOSPITAL SYSTEM 1000 MEDICAL CENTER BLVD LAWRENCEVILLE GA 30045 (678) 995-4321 530 110089 COFFEE REGIONAL MEDICAL CENTER 1101 OCILLA RD P O BOX 1248 DOUGLAS GA 31533 (229) 384-1900 291 110091 ROCKDALE HOSPITAL 1412 MILSTEAD AV NE CONYERS GA 30207 (404) 922-8901 841 110092 DODGE COUNTY HOSPITAL GRIFFIN ST BOX 706 EASTMAN GA 31023 (478) 374-4000 380 110095 TIFT REGIONAL MEDICAL CENTER 901 E 18TH ST TIFTON GA 31793 (229) 382-7120 900 110096 CANDLER COUNTY HOSPITAL CEDAR RD BOX 597 METTER GA 30439 (912) 685-5741 180 110098 BACON COUNTY HOSPITAL 302 S WAYNE ST BOX 745 ALMA GA 31510 (912) 632-8961 11 110100 JEFFERSON HOSPITAL 1067 PEACHTREE ST LOUISVILLE GA 30434 (478) 625-7000 620 110101 MEMORIAL HOSPITAL OF ADEL INC 706 N PARRISH AVE BOX 677 ADEL GA 31620 (229) 896-6313 311 110104 CRISP REGIONAL HOSPITAL 902 7TH STREET NORTH CORDELE GA 31015 (229) 276-3100 340 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 31 Provider ID Hospital Name Address City State ZIP Telephone County 110105 COLQUITT REGIONAL MEDICAL CENTER 3131 THOMASVILLE HWY BOX 40 MOULTRIE GA 31768 (229) 985-3420 300 110107 MEDICAL CENTER OF CENTRAL GEORGIA 777 HEMLOCK ST BOX 6000 MACON GA 31208 (478) 633-1450 90 110109 EMANUEL COUNTY HOSPITAL 117 KITE RD BOX 7 SWAINSBORO GA 30401 (478) 237-9911 440 110111 MCDUFFIE REGIONAL MEDICAL CENTER 521 HILL ST SW THOMSON GA 30824 (706) 595-1411 702 110112 BERRIEN COUNTY HOSPITAL 1221 E MCPHERSON AVE NASHVILLE GA 31639 (229) 686-7471 80 110113 BURKE MEDICAL CENTER 351 LIBERTY ST WAYNESBORO GA 30830 (706) 554-4435 150 110114 WILLS MEMORIAL HOSPITAL 120 GORDON ST PO BOX 370 WASHINGTON GA 30673 (706) 678-2151 972 110115 ATLANTA MEDICAL CENTER 303 PARKWAY DR NE ATLANTA GA 30312 (404) 265-4000 470 110118 MITCHELL COUNTY HOSPITAL 90 EAST STEPHENS STREET CAMILLA GA 31730 (229) 336-5284 750 110120 POLK MEDICAL CENTER 424 N MAIN ST CEDARTOWN GA 30125 (770) 748-2500 830 110121 GRADY GENERAL HOSPITAL 1155 5TH ST SE CAIRO GA 31728 (229) 377-1150 510 110122 SOUTH GEORGIA MEDICAL CENTER 2501 NORTH PATTERSON ST PO BOX 1727 VALDOSTA GA 31603 (229) 333-1000 700 110124 WAYNE MEMORIAL HOSPITAL 865 S 1ST ST JESUP GA 31545 (912) 427-6811 960 110125 FAIRVIEW PARK HOSPITAL 200 INDUSTRIAL BLVD DUBLIN GA 31021 (478) 275-2000 660 110128 MEADOWS REGIONAL MEDICAL CENTER INC 1703 MEADOWS LAND BOX 1048 VIDALIA GA 30474 (912) 537-8921 901 110129 ST FRANCIS HOSPITAL 2122 MANCHESTER EXPRESSWAY BOX 7000 COLUMBUS GA 31995 (706) 596-4020 780 110130 IRWIN COUNTY HOSPITAL 710 N IRWIN AVE OCILLA GA 31774 (229) 468-7411 601 110132 MEMORIAL HOSPITAL 1500 E SHOTWELL ST BAINBRIDGE GA 31717 (912) 246-3500 360 110135 TAYLOR REGIONAL HOSPITAL P O BOX 1297 MACON HIGHWAY HAWKINSVILLE GA 31036 (478) 783-0200 831 110136 MEDICAL SURG CENTER OF CENTRAL STATE VINSON HWY MILLEDGEVILLE GA 31062 (478) 453-5562 30 110142 EVANS MEMORIAL HOSPITAL 200 N RIVER ST BOX 518 CLAXTON GA 30417 (912) 739-2611 441 110143 WELLSTAR COBB HOSPITAL 3950 AUSTELL RD AUSTELL GA 30001 (770) 944-5000 290 110146 CAMDEN MEDICAL CENTER 2000 DAN PROCTOR DRIVE PO BOX 805 SAINT MARYS GA 31558 (912) 546-4200 170 110149 MOUNTAINSIDE MEDICAL CENTER 1266 EAST CHURCH STREET JASPER GA 30143 (706) 692-2441 812 110150 OCONEE REGIONAL MEDICAL CENTER 821 N COBB ST POST OFFICE BOX 690 MILLEDGEVILLE GA 31061 (478) 454-3550 30 110153 PERRY GENERAL HOSPITAL 1120 MORNINGSIDE DR PERRY GA 31069 (478) 987-3600 600 110161 NORTHSIDE HOSPITAL 1000 JOHNSON FERRY RD NE ATLANTA GA 30342 (404) 851-8000 470 110163 HCA PALMYRA MEDICAL CENTERS 2000 PALMYRA RD BOX 1908 ALBANY GA 31701 (229) 434-2000 390 110164 COLISEUM MEDICAL CENTERS 350 HOSPITAL DR MACON GA 31213 (912) 765-4865 90 110165 SOUTHERN REGIONAL MEDICAL CENTER 11 SW UPPER RIVERDALE RD RIVERDALE GA 30274 (770) 991-8000 280 110166 MIDDLE GEORGIA HOSPITAL 888 PINE ST MACON GA 31297 (478) 751-1111 90 110168 REDMOND REGIONAL MEDICAL CENTER 501 REDMOND RD ROME GA 30164 (706) 291-0291 460 110172 EMORY DUNWOODY MEDICAL CENTER 4575 N SHALLOWFORD RD ATLANTA GA 30338 (770) 454-2000 470 110177 DOCTORS HOSPITAL 3651 WHEELER RD AUGUSTA GA 30909 (706) 863-3232 840 110179 EMORY PARKWAY MEDICAL CENTER 1000 THORNTON RD LITHIA SPRINGS GA 30122 (770) 732-7777 400 110183 EMORY-ADVENTIST HOSPITAL 3949 SOUTH COBB DRIVE SMYRNA GA 30080 (770) 434-0710 290 110184 WELLSTAR DOUGLAS HOSPITAL 8954 HOSPITAL DRIVE DOUGLASVILLE GA 30134 (770) 949-1500 400 110186 COLUMBUS DOCTORS HOSPITAL, INC 616 W 19 ST COLUMBUS GA 31901 (706) 571-4381 780 110187 CHASTATEE REGIONAL HOSPITAL 1111 MOUNTAIN DR DAHLONEGA GA 30533 (706) 864-6136 701 110189 FANNIN REGIONAL HOSPITAL 2855 OLD HIGHWAY 5 NORTH BLUE RIDGE GA 30513 (706) 632-3711 450 110190 FLINT RIVER COMMUNITY HOSPITAL 509 SUMTER ST BOX 574 MONTEZUMA GA 31063 (478) 472-3246 381 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 32 Provider ID Hospital Name Address City State ZIP Telephone County 110191 HENRY GENERAL HOSPITAL BOX 538 STOCKBRIDGE GA 30281 (770) 389-2200 591 110192 EMORY EASTSIDE MEDICAL CENTER 1700 MEDICAL WAY SNELLVILLE GA 30078 (770) 479-0200 530 110193 NEWNAN HOSPITAL PO BOX 997 NEWNAN GA 30264 (770) 253-2330 320 110194 DONALSONVILLE HOSPITAL INC 102 HOSPITAL CIRCLE BOX 677 DONALSONVILLE GA 31745 (229) 524-5217 851 110198 NORTH FULTON REGIONAL HOSPITAL 3000 HOSPITAL DR ROSWELL GA 30076 (770) 751-2500 470 110200 HUGHSTON SPORTS MEDICINE HOSPITAL 100 FIRST COURT PO BOX 7188 COLUMBUS GA 31908 (706) 576-2100 780 110201 MACON NORTHSIDE HOSPITAL 400 CHARTER BOX 4627 MACON GA 31210 (478) 477-9520 90 110203 WESLEY WOODS GERIATRIC HOSPITAL 1821 CLIFTON RD NE ATLANTA GA 30329 (404) 728-6200 370 110205 NORTH GEORGIA MEDICAL CENTER JASPER ROAD ELLIJAY GA 30540 (706) 276-4741 471 110209 TURNING POINT HOSPITAL 319 BYPASS BOX 1177 MOULTRIE GA 31768 (229) 985-4815 300 110212 SMITH NORTHVIEW HOSPITAL 4280 NORTH VALDOSTA ROAD VALDOSTA GA 31602 (229) 671-2000 700 110215 FAYETTE COMMUNITY HOSPITAL 1255 HIGHWAY 54 WEST FAYETTEVILLE GA 30214 (770) 719-7070 451 110219 SOUTH FULTON MEDICAL CENTER 1170 CLEVELAND AVENEUE EAST POINT GA 30344 (404) 305-3550 470 111300 SOUTHWEST GEORGIA REGIONAL MEDICAL CTR 109 RANDOLPH STREET CUTHBERT GA 31740 (229) 732-2181 835 111301 TAYLOR TELFAIR REGIONAL HOSPITAL HIGHWAY 341 MC RAE GA 31055 (229) 868-5621 884 111302 BLECKLEY MEMORIAL HOSPITAL 408 PEACOCK STREET COCHRAN GA 31014 (478) 934-6211 100 111303 JASPER MEMORIAL HOSPITAL 898 COLLEGE STREET MONTICELLO GA 31064 (706) 468-6411 611 111304 MORGAN MEMORIAL HOSPITAL 1077 MAIN STREET MADISON GA 30650 (706) 342-1667 771 111305 MILLER COUNTY HOSPITAL 209 N CUTHBERT STREET COLQUITT GA 31737 (229) 758-3385 741 111306 EFFINGHAM COUNTY HOSPITAL GA HIGHWAY 119 SPRINGFIELD GA 31329 (912) 754-6451 421 111308 CLINCH MEMORIAL HOSPITAL 524 CARSWELL STREET HOMERVILLE GA 31634 (912) 487-5211 281 111309 CALHOUN MEMORIAL HOSPITAL 209 ACADEMY AVENUE SE ARLINGTON GA 31713 (229) 725-4272 161 111310 PEACH REGIONAL MEDICAL CENTER 601 NORTH CAMILLIA BOULEVARD FORT VALLEY GA 31030 (478) 825-8691 811 111311 JENKINS COUNTY HOSPITAL 931 EAST WINTHROPE AVENUE MILLEN GA 30442 (478) 478-4221 630 111312 SCREVEN COUNTY HOSPITAL 215 MIMS ROAD SYLVANIA GA 30467 (912) 564-7426 850 111313 PUTNAM GENERAL HOSPITAL 101 GREENSBORO HIGHWAY EATONTON GA 31024 (706) 485-2711 832 111314 EARLY MEMORIAL HOSPITAL 630 COLUMBIA ROAD BLAKELY GA 31723 (229) 723-4241 410 111315 CHARLTON MEMORIAL HOSPITAL 1203 NORTH THIRD STREET FOLKSTON GA 31537 (912) 496-2531 210 111316 GEORGIA BAPTIST MERIWETHER HOSPITAL 5995 SPRING STREET WARM SPRINGS GA 31830 (706) 655-3331 740 111318 MONROE COUNTY HOSPITAL 88 MARTIN LUTHER KING JR DRIVE FORSYTH GA 31029 (478) 994-2521 760 111319 SYLVAN GROVE HOSPITAL 1050 MCDONOUGH JACKSON GA 30233 (770) 775-7861 160 111320 HIGGINS GENERAL HOSPITAL 200 ALLEN MEMORIAL DRIVE BREMEN GA 30110 (770) 824-2000 570 111321 WHEELER COUNTY HOSPITAL THIRD STREET GLENWOOD GA 30428 (912) 523-5113 962 111322 STEWART WEBSTER HOSPITAL 300 ALSTON STREET RICHLAND GA 31825 (229) 887-3366 862 111323 TATTNALL COMMUNITY HOSPITAL HIGHWAY 21 S RTE 1 BOX 261 REIDSVILLE GA 30453 (912) 255-4731 882 111324 CHATUGE REGIONAL HOSPITAL 110 EAST MAIN STREET HIAWASSEE GA 30546 (706) 896-2222 902 111325 WILLS MEMORIAL HOSPITAL 120 GORDON STREET WASHINGTON GA 30673 (706) 678-2151 972 111326 LOUIS SMITH MEMORIAL HISPITAL 852 W THIGPEN AVE LAKELAND GA 31635 (229) 482-2401 652 111327 BACON COUNTY HOSPITAL 302 SOUTH WAYNE STREET ALMA GA 31510 (912) 632-5000 11 111328 PHOEBE WORTH MEDICAL CENTER 807 SOUTH ISABELLA STREET SYLVESTER GA 31791 (229) 776-6961 980 112000 ROOSEVELT WARM SPRINGS INST FOR REHAB PO BOX 1000 WARM SPRINGS GA 31830 (404) 655-2065 740 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 33 Provider ID Hospital Name Address City State ZIP Telephone County 112003 SHEPHERD SPINAL CENTER 2020 PEACHTREE RD NW ATLANTA GA 30309 (404) 352-2020 470 112004 KINDRED HOSPITAL - ATLANTA 705 JUNIPER STREET NE ATLANTA GA 30366 (404) 873-2871 470 112005 WESLEY WOODS LTC 1821 CLIFTON RD NE BRIARCLIFF GA 30329 (404) 728-6200 370 112006 DECATUR HOSPITAL 450 NORTH CANDLER STREET DECATUR GA 30030 (404) 377-0221 370 112007 WELLSTAR WINDY HILL HOSPITAL 2540 WINDY HILL RD MARIETTA GA 30067 (770) 644-1000 290 112008 SPECIALTY HOSPITAL - SELECT AUGUSTA 3651 WHEELER ROAD/FOURTH FLOOR AUGUSTA GA 30909 (706) 651-4402 840 112009 SELECT SPECIALTY HOSPITAL-ATLANTA 550 PEACHTREE STREET NE ATLANTA GA 30327 (404) 350-4623 470 112010 SPECIALTY HOSPITAL AT FLOYD MED CTR 304 TURNER MCCALL BLVD ROME GA 30162 (706) 802-4100 460 113026 WALTON REHABILITATION HOSP 1355 INDEPENDENCE DR AUGUSTA GA 30901 (706) 724-7746 840 113027 HEALTHSOUTH CENTRAL GA REHAB HOSPITAL 3351 NORTHSIDE DR MACON GA 31210 (478) 471-3500 90 113300 EGLESTON CHILDREN'S HOSP AT EMORY, INC 1405 CLIFTON RD NE ATLANTA GA 30322 (404) 325-6000 370 113301 SCOTTISH RITE CHILDRENS MED CTR INC 1001 JOHNSON FERRY RD ATLANTA GA 30342 (404) 256-5252 470 114008 COASTAL HARBOR TREATMENT CTR 1150 CORNELL AVE SAVANNAH GA 31406 (912) 354-3911 220 114010 PEACHFORD BEHAVIORAL HEALTH SYSTEM 2151 PEACHFORD RD NE ATLANTA GA 30338 (770) 455-3200 470 114012 RIDGEVIEW INSTITUTE 3995 S COBB DR SMYRNA GA 30080 (770) 434-4567 290 114013 WEST CENTRAL GA REG HOSP 3000 SCHATULGA RD BOX 12435 COLUMBUS GA 31995 (706) 568-5203 780 114014 NW GA REGIONAL HOSP 400 REDMOND ROAD ROME GA 30161 (706) 295-6246 460 114015 COLISEUM PSYCHIATRIC HOSPITAL 340 HOSPITAL DR BOX 9366 MACON GA 31201 (229) 741-1355 90 114016 FOCUS BY THE SEA 2927 DEMERE RD SAINT SIMONS ISLAND GA 31522 (912) 638-1999 490 114018 CENTRAL STATE HOSPITAL PSYC SVCS DIV POWELL BUILDING DISTINCT PART MILLEDGEVILLE GA 31062 (478) 445-5540 30 114019 GEORGIA REGIONAL HOSP ATLANTA 3073 PANTHERSVILLE ROAD DECATUR GA 30034 (404) 243-2100 370 114021 SOUTHWESTERN STATE HOSPITAL 400 S PINETREE BLVD BOX 1378 THOMASVILLE GA 31792 (229) 227-3020 890 114023 BRADLEY CENTER OF ST FRANCIS,THE 2000 16TH AVE PO BOX 7000 COLUMBUS GA 31908 (706) 320-3700 780 114028 GA REGIONAL HOSP SAV 1915 EISENHOWER DR SAVANNAH GA 31416 (912) 356-2045 220 114029 GEORGIA REGIONAL HOSP AT AUGUSTA 3405 MIKE PADGETT HWY AUGUSTA GA 30906 (706) 792-7066 840 114032 ANCHOR HOSPITAL 5454 YORKTOWNE DRIVE COLLEGE PARK GA 30349 (770) 991-6044 470 120001 QUEENS MEDICAL CENTER 1301 PUNCHBOWL ST HONOLULU HI 96813 (808) 538-9011 20 120002 MAUI MEMORIAL MEDICAL CENTER 221 MAHALANI STREET WAILUKU HI 96793 (808) 244-9056 50 120004 WAHIAWA GENERAL HOSPITAL 128 LEHUA STREET WAHIAWA HI 96786 (808) 621-8411 20 120005 HILO MEDICAL CENTER 1190 WAIANUENUE AVENUE HILO HI 96720 (808) 974-4700 10 120006 CASTLE MEDICAL CENTER 640 ULUKAHIKI ST KAILUA HI 96734 (808) 598-0221 20 120007 KUAKINI MEDICAL CENTER 347 N KUAKINI STREET HONOLULU HI 96817 (808) 536-2236 20 120010 ST FRANCIS MEDICAL CENTER 2230 LILIHA STREET HONOLULU HI 96817 (808) 553-5331 20 120011 KAISER FOUNDATION HOSPITAL 3288 MOANALUA RD HONOLULU HI 96819 (808) 432-0000 20 120014 WILCOX MEMORIAL HOSPITAL 3420 KUHIO HIGHWAY LIHUE HI 96766 (808) 245-1100 40 120016 HALE HO'OLA HAMAKUA 45-547 PLUMERIA STREET HONOKAA HI 96727 (808) 775-7211 10 120019 KONA COMMUNITY HOSPITAL 69 HAUKAPILA STREET KEALAKEKUA HI 96750 (808) 322-9311 10 120022 STRAUB CLINIC AND HOSPITAL 888 SO KING STREET HONOLULU HI 96813 (808) 522-4000 20 120024 KULA HOSPITAL 100 KEOKEA PLACE KULA HI 96790 (808) 878-1221 50 120025 SAMUEL MAHELONA MEMORIAL HOSPITAL 4800 KAWAIHAU RD KAPAA HI 96746 (808) 822-4961 40 120026 KAPIOLANI MEDICAL CENTER AT PALI MOMI 98-1079 MOANALUA ROAD AIEA HI 96701 (808) 486-6000 20 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 34 Provider ID Hospital Name Address City State ZIP Telephone County 120027 ST FRANCIS MEDICAL CENTER-WEST 91-2141 FORT WEAVER ROAD EWA BEACH HI 96706 (808) 678-7000 20 120028 NORTH HAWAII COMMUNITY HOSPITAL 67 1125 MAMALAHOA HIGHWAY KAMUELA HI 96743 (808) 885-4444 10 121300 KAUAI VETERANS MEMEORIAL HOSPITAL 4643 WAIMEA CANYON DRIVE WAIMEA HI 96796 (808) 338-9431 40 121301 KAU HOSPITAL 1 KAMANI STREET PAHALA HI 96777 (808) 838-8331 10 121302 KOHALA HOSPITAL 54-383 HOSPITAL ROAD KAPAAU HI 96755 (808) 889-6211 10 121303 MOLOKAI GENERAL HOSPITAL PO BOX 408 KAUNAKAKAI HI 96748 (808) 553-5331 50 121304 KAHUKU HOSPITAL 56117 PUALALEA STEET KAHUKU HI 96731 (808) 293-9221 20 121305 LANAI COMMUNITY HOSPITAL 628 7TH STREET LANAI CITY HI 96763 (808) 565-6411 50 122001 LEAHI HOSPITAL 3675 KILAUEA AVE HONOLULU HI 96816 (808) 733-8000 20 123025 REHABILITATION HOSPITAL OF THE PACIFIC 226 N KUAKINI STREET HONOLULU HI 96817 (808) 531-3511 20 123300 KAPIOLANI MED CTR FOR WOMEN & CHILDREN 1319 PUNAHOU STREET HONOLULU HI 96826 (808) 983-6000 20 124001 KAHI MOHALA 91-2301 FORT WEAVER ROAD EWA BEACH HI 96706 (808) 671-8511 20 130002 MAGIC VALLEY REGIONAL MEDICAL CENTER 650 ADDISON AVE W, BOX 409 TWIN FALLS ID 83301 (208) 737-2100 410 130003 ST JOSEPH REGIONAL MEDICAL CENTER 415 SIXTH ST LEWISTON ID 83501 (208) 743-2511 340 130005 POCATELLO REGIONAL MEDICAL CENTER 777 HOSPITAL WAY POCATELLO ID 83201 (208) 234-0777 20 130006 ST LUKES REGIONAL MEDICAL CENTER 190 EAST BANNOCK BOISE ID 83712 (208) 381-2353 0 130007 ST ALPHONSUS REGIONAL MEDICAL CENTER 1055 NORTH CURTIS ROAD BOISE ID 83704 (208) 367-2121 0 130008 ST MARYS HOSPITAL 701 LEWISTON STREET PO BOX 137 COTTONWOOD ID 83522 (208) 962-3251 240 130009 CLEARWATER VALLEY HOSPITAL 301 CEDAR OROFINO ID 83544 (208) 476-4555 170 130011 GRITMAN MEDICAL CENTER 700 SOUTH MAIN STREET MOSCOW ID 83843 (208) 882-4511 280 130013 MERCY MEDICAL CENTER 1512 TWELFTH AVE ROAD NAMPA ID 83651 (208) 467-1171 130 130014 WEST VALLEY MEDICAL CENTER 1717 ARLINGTON CALDWELL ID 83605 (208) 459-4641 130 130018 EASTERN IDAHO REGIONAL MED CENTER 3100 CHANNING WAY, BOX 2077 IDAHO FALLS ID 83403 (208) 529-6111 90 130021 LOST RIVERS DISTRICT HOSPITAL 551 HIGHLAND DRIVE PO BOX 145 ARCO ID 83213 (208) 527-8206 110 130022 BINGHAM MEMORIAL HOSPITAL 98 POPLAR ST BOX 751 BLACKFOOT ID 83221 (208) 785-4100 50 130024 BONNER GENERAL HOSPITAL 502 NORTH THIRD BOX 1448 SANDPOINT ID 83864 (208) 263-1441 80 130025 MADISON MEMORIAL HOSPITAL 450 EAST MAIN PO BOX 310 REXBURG ID 83440 (208) 356-3691 320 130026 CASSIA REGIONAL MEDICAL CENTER 1501 HILAND AVENUE,PO BOX 489 BURLEY ID 83318 (208) 678-4444 150 130028 PORTNEUF REGIONAL MEDICAL CENTER 651 MEMORIAL DRIVE POCATELLO ID 83201 (208) 239-1000 20 130045 FRANKLIN COUNTY MEDICAL CENTER 44 NORTH FIRST EAST PRESTON ID 83263 (208) 852-0137 200 130049 KOOTENAI MEDICAL CENTER 2003 LINCOLN WAY COEUR D'ALENE ID 83814 (208) 666-2000 270 130062 IDAHO FALLS RECOVERY CENTER 1957 17TH STREET IDAHO FALLS ID 83404 (208) 529-5285 90 130063 TREASURE VALLEY HOSPITAL 8800 WEST EMERALD STREET BOISE ID 83704 (208) 373-5000 0 130064 ST LUKE'S MEDICAL CENTER - WOOD RIVER 100 HOSPITAL DRIVE, P O BOX 100 KETCHUM ID 83340 (208) 727-8800 60 131301 BOUNDARY COUNTY COMMUNITY HOSPITAL HCR61, BOX 61A, 6640 KANIKSU ST BONNERS FERRY ID 83805 (208) 267-3141 100 131302 GOODING COUNTY MEMORIAL HOSPITAL 1120 MONTANA STREET GOODING ID 83330 (208) 934-4433 230 131303 ONEIDA COUNTY HOSPITAL 150 N 200 WEST, P O BOX 126 MALAD ID 83252 (208) 766-2231 350 131304 HARMS MEMORIAL HOSPITAL 510 ROOSEVELT AVENUE, P O BOX 20 AMERICAN FALLS ID 83211 (208) 226-3200 380 131305 STEELE MEMORIAL HOSPITAL 811 MAIN STREET (PO BOX 700) SALMON ID 83467 (208) 756-4291 290 131307 WEISER MEMORIAL HOSPITAL 645 EAST 5TH WEISER ID 83672 (208) 549-0370 0 131308 CASCADE MEDICAL CENTER P O BOX 1330, 402 OLD STATE HIGHWAY CASCADE ID 83611 (208) 382-4242 420 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 35 Provider ID Hospital Name Address City State ZIP Telephone County 131309 CARIBOU MEMORIAL HOSPITAL 300 SOUTH 3RD WEST SODA SPRINGS ID 83276 (208) 547-3341 140 131310 ST BENEDICT'S FAMILY MEDICAL CENTER 709 NORTH LINCOLN, PO BOX 586 JEROME ID 83338 (208) 324-4301 260 131311 ELMORE MEDICAL CENTER 895 N SIXTH EAST, PO BOX 1270 MOUNTAIN HOME ID 83647 (208) 587-8401 190 131312 MCCALL MEMORIAL HOSPITAL 1000 STATE STREET MCCALL ID 83638 (208) 634-2221 420 131313 TETON VALLEY HOSPITAL AND SURGICENTER 283 NORTH FIRST EAST DRIGGS ID 83422 (208) 354-2383 400 131314 SHOSHONE MEDICAL CENTER JACOB'S GULCH KELLOGG ID 83837 (208) 784-1221 390 131315 SYRINGA GENERAL HOSPITAL 607 WEST MAIN STREET GRANGEVILLE ID 83530 (208) 983-1700 240 131316 BEAR LAKE MEMORIAL HOSPITAL 164 SOUTH FIFTH MONTPELIER ID 83254 (208) 847-1630 30 131317 BENEWAH COMMUNITY HOSPITAL 229 7TH STREET SAINT MARIES ID 83861 (208) 245-5551 40 131318 WALTER KNOX MEMORIAL HOSPITAL 1202 EAST LOCUST EMMETT ID 83617 (208) 365-3561 220 131319 MINIDOKA MEMORIAL HOSPITAL 1224 EIGHT STREET RUPERT ID 83350 (208) 436-0481 330 133025 IDAHO ELKS REHABILITATION HOSPITAL 600 N ROBBINS ROAD, PO BOX 1100 BOISE ID 83701 (208) 489-4444 0 134002 INTERMOUNTAIN HOSPITAL 303 N ALLUMBAUGH ST BOISE ID 83704 (208) 377-8400 70 134009 SUNHEALTH BEHAVIORAL HEALTH SYSTEM 8050 NORTHVIEW STREET BOISE ID 83704 (208) 327-0504 0 134010 IDAHO STATE HOSPITAL SOUTH 700 EAST ALICE (BOX 400) BLACKFOOT ID 83221 (208) 785-1200 50 134011 PORTNEUF VALLEY HOSPITAL 2200 EAST TERRY STREET POCATELLO ID 83201 (208) 232-2570 20 140001 GRAHAM HOSPITAL ASSOCIATION 210 WEST WALNUT STREET CANTON IL 61520 (309) 647-5240 370 140002 ALTON MEMORIAL HOSPITAL ONE MEMORIAL DRIVE ALTON IL 62002 (618) 463-7311 680 140003 SARAH D CULBERTSON MEMORIAL HOSPITAL 238 S CONGRESS RUSHVILLE IL 62681 (217) 322-4321 921 140004 ABRAHAM LINCOLN MEMORIAL HOSPITAL 315 8TH ST LINCOLN IL 62656 (217) 732-2161 620 140005 HARDIN COUNTY GENERAL HOSPITAL FERRELL ROAD ROSICLARE IL 62982 (618) 285-6634 421 140007 PROVENA ST JOSEPH MEDICAL CENTER 333 N MADISON JOLIET IL 60435 (815) 725-7133 989 140008 GOTTLIEB MEMORIAL HOSPITAL 701 WEST NORTH AVE MELROSE PARK IL 60160 (708) 450-4949 141 140010 EVANSTON NORTHWESTERN HEALTHCAR 2650 RIDGE AVE EVANSTON IL 60201 (847) 570-2005 141 140011 HERRIN HOSPITAL 201 S 14TH ST HERRIN IL 62948 (618) 942-2171 990 140012 KATHERINE SHAW BETHEA HOSPITAL 403 E 1ST ST DIXON IL 61021 (815) 288-5531 600 140013 PROCTOR COMMUNITY HOSPITAL 5409 N KNOXVILLE AVE PEORIA IL 61614 (309) 691-1000 800 140015 BLESSING HOSPITAL BROADWAY AT 11TH ST QUINCY IL 62301 (217) 223-1200 0 140016 CLAY COUNTY HOSPITAL 911 STACY BURK DRIVE FLORA IL 62839 (618) 662-2131 120 140018 MT SINAI HOSPITAL MEDICAL CENTER 15TH STREET AT CALIFORNIA CHICAGO IL 60608 (773) 257-6751 141 140019 SHELBY MEMORIAL HOSPITAL 200 S CEDAR ST SHELBYVILLE IL 62565 (217) 774-3961 950 140024 LAWRENCE COUNTY MEMORIAL HOSPITAL 2200 WEST STATE ST LAWRENCEVILLE IL 62439 (618) 943-1000 590 140026 ST MARYS HOSPITAL 111 E SPRING STREATOR IL 61364 (815) 673-2311 580 140027 PERRY MEMORIAL HOSPITAL 530 PARK AVENUE E PRINCETON IL 61356 (815) 875-2811 50 140029 RUSH COPLEY MEMORIAL HOSPITAL 2000 OGDEN AVENUE AURORA IL 60504 (630) 978-6200 530 140030 SHERMAN HOSPITAL 934 CENTER STREET ELGIN IL 60120 (847) 742-9800 530 140032 ST ANTHONYS MEMORIAL HOSPITAL 503 N MAPLE STREET EFFINGHAM IL 62401 (217) 342-2121 330 140033 ST THERESE MEDICAL CENTER 2615 WASHINGTON ST WAUKEGAN IL 60085 (708) 249-3900 570 140034 ST MARYS HOSPITAL 400 NORTH PLEASANT CENTRALIA IL 62801 (618) 532-6731 690 140036 KEWANEE HOSPITAL 719 ELLIOTT ST KEWANEE IL 61443 (309) 853-3361 450 140037 MARSHALL BROWNING HOSPITAL 900 N WASHINGTON DU QUOIN IL 62832 (618) 542-2146 810 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 36 Provider ID Hospital Name Address City State ZIP Telephone County 140038 ROCHELLE COMMUNITY HOSPITAL 900 N 2ND ST ROCHELLE IL 61068 (815) 562-2181 790 140040 GALESBURG COTTAGE HOSPITAL 695 N KELLOGG ST GALESBURG IL 61401 (309) 343-8131 560 140042 MASSAC MEMORIAL HOSPITAL MEMORIAL HEIGHTS METROPOLIS IL 62960 (618) 524-2176 720 140043 CGH MEDICAL CENTER 100 EAST LEFEVRE ROAD STERLING IL 61081 (815) 625-0400 988 140045 FAYETTE COUNTY HOSPITAL 7TH AND TAYLOR VANDALIA IL 62471 (618) 283-1231 340 140046 GOOD SAMARITAN REGIONAL HLTH CENTER 605 N 12TH STREET MOUNT VERNON IL 62864 (618) 242-4600 490 140048 EHS TRINITY HOSPITAL 2320 E 93RD ST CHICAGO IL 60617 (312) 978-2000 141 140049 WEST SUBURBAN HOSPITAL MED CENTER ERIE AT AUSTIN BOULEVARD OAK PARK IL 60302 (708) 383-6200 141 140051 RUSH NORTH SHORE MEDICAL CENTER 9600 GROSS POINT ROAD SKOKIE IL 60076 (847) 677-9600 141 140052 SAINT ANTHONY HEALTH CENTER ST ANTHONYS WAY ALTON IL 62002 (618) 465-4502 680 140053 ST JOHNS HOSPITAL 800 E CARPENTER ST SPRINGFIELD IL 62702 (217) 544-6464 920 140054 MAC NEAL MEMORIAL HOSPITAL 3249 SOUTH OAK PARK AVENUE BERWYN IL 60402 (708) 783-9100 141 140058 PASSAVANT AREA HOSPITAL 1600 W WALNUT ST JACKSONVILLE IL 62650 (217) 245-9551 770 140059 JERSEY COMMUNITY HOSPITAL DISTRICT 400 MAPLE SUMMIT ROAD JERSEYVILLE IL 62052 (618) 498-6402 500 140061 RED BUD REGIONAL HOSPITAL 325 SPRING STREET RED BUD IL 62278 (618) 282-3831 870 140062 PALOS COMMUNITY HOSPITAL 12251 SOUTH 80TH AVENUE PALOS HEIGHTS IL 60463 (708) 923-4000 141 140063 OAK PARK HOSPITAL 520 S MAPLE AVE OAK PARK IL 60304 (708) 383-9300 141 140064 ST MARY MEDICAL CENTER 3333 NORTH SEMINARY GALESBURG IL 61401 (309) 344-3161 560 140065 LA GRANGE MEMORIAL HOSPITAL 5101 WILLOW SPRINGS RD LA GRANGE IL 60525 (708) 352-1200 141 140066 ST MARYS HOSPITAL OF EAST ST LOUIS 129 N 8TH ST EAST SAINT LOUIS IL 62201 (618) 274-1900 900 140067 SAINT FRANCIS MEDICAL CENTER 800 NE GLEN OAK AVE PEORIA IL 61603 (309) 655-2850 800 140068 ROSELAND COMMUNITY HOSPITAL 45 W 111TH STREET CHICAGO IL 60628 (312) 995-3000 141 140075 COLUMBIA MICHAEL REESE HOS & MED CTR 2929 S ELLIS CHICAGO IL 60616 (312) 791-2168 141 140077 TOUCHETTE REGIONAL HOSPITAL INC 5900 BOND AVENUE CENTREVILLE IL 62207 (618) 332-3060 900 140080 ST FRANCIS HOSPITAL OF EVANSTON 355 RIDGE AVE EVANSTON IL 60202 (708) 492-4000 141 140082 LOUIS A WEISS MEMORIAL HOSPITAL 4646 N MARINE DRIVE CHICAGO IL 60640 (312) 878-8700 141 140083 LORETTO HOSPITAL 645 SOUTH CENTRAL AVE CHICAGO IL 60644 (312) 626-4300 141 140084 VICTORY MEMORIAL HOSPITAL 1324 NORTH SHERIDAN ROAD WAUKEGAN IL 60085 (847) 360-4000 570 140088 UNIVERSITY OF CHICAGO HOSPITALS 5841 SOUTH MARYLAND CHICAGO IL 60637 (312) 702-1000 141 140089 MC DONOUGH DISTRICT HOSPITAL 525 EAST GRANT STREET MACOMB IL 61455 (309) 833-4101 630 140091 CARLE FOUNDATION HOSPITAL 611 WEST PARK STREET URBANA IL 61801 (217) 337-3441 90 140093 UNITED SAMARITANS MED CENTER-LOGAN 812 N LOGAN DANVILLE IL 61832 (217) 443-5000 982 140094 ST ELIZABETH HOSPITAL OF CHICAGO INC 1431 N CLAREMONT AVE CHICAGO IL 60622 (312) 278-2000 141 140095 ST ANTHONYS HOSPITAL 2875 WEST 19TH STREET CHICAGO IL 60623 (312) 521-1710 141 140100 MIDWESTERN REGION MED CENTER 2520 ELISHA AVENUE ZION IL 60099 (847) 872-4561 570 140101 MORRIS HOSPITAL 150 W HIGH ST MORRIS IL 60450 (815) 942-8244 400 140102 ST VINCENT MEMORIAL HOSPITAL 201 EAST PLEASANT ST TAYLORVILLE IL 62568 (217) 824-3331 100 140103 ST BERNARD HOSPITAL 326 W 64TH ST CHICAGO IL 60621 (312) 962-4100 141 140105 HOLY FAMILY MEDICAL CENTER 100 N RIVER RD DES PLAINES IL 60016 (847) 297-1800 141 140109 SPARTA COMMUNITY HOSPITAL DISTRICT 818 E BROADWAY SPARTA IL 62286 (618) 443-2177 870 140110 COMMUNITY HOSPITAL OF OTTAWA 1100 EAST NORRIS DRIVE OTTAWA IL 61350 (815) 433-3100 580 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 37 Provider ID Hospital Name Address City State ZIP Telephone County 140113 COVENANT MEDICAL CTR CHAMPAIGN-URBANA 1400 WEST PARK AVENUE URBANA IL 61801 (217) 337-2000 90 140114 SWEDISH COVENANT HOSPITAL 5145 N CALIFORNIA AVE CHICAGO IL 60625 (312) 878-8200 141 140115 THOREK HOSPITAL AND MEDICAL CENTER 850 W IRVING PARK RD CHICAGO IL 60613 (312) 525-6780 141 140116 NORTHERN ILLINOIS MEDICAL CENTER 4201 MEDICAL CENTER DRIVE MCHENRY IL 60050 (815) 344-5000 640 140117 RESURRECTION MEDICAL CENTER 7435 W TALCOTT CHICAGO IL 60631 (773) 774-8000 141 140118 ST FRANCIS HOSPITAL & HEALTH CENTER 12935 S GREGORY BLUE ISLAND IL 60406 (708) 597-2000 141 140119 RUSH-PRESBYTERIAN-ST LUKES MED CTR 1653 WEST CONGRESS PARKWAY CHICAGO IL 60612 (312) 942-5000 141 140120 PEKIN MEMORIAL HOSPITAL COURT AND 14TH STREET PEKIN IL 61554 (309) 347-1151 980 140121 HOPEDALE HOSPITAL 107 TREMONT STREET HOPEDALE IL 61747 (309) 449-3321 980 140122 HINSDALE HOSPITAL 120 NORTH OAK ST HINSDALE IL 60521 (630) 856-9000 250 140124 COOK COUNTY HOSPITAL 1825 W HARRISON ST CHICAGO IL 60612 (312) 633-8533 141 140125 ST ELIZABETH MEDICAL CENTER 2100 MADISON AVENUE GRANITE CITY IL 62040 (618) 798-3000 680 140127 BROMENN HEALTHCARE VIRGINIA AT FRANKLIN NORMAL IL 61761 (309) 454-0700 650 140129 WABASH GENERAL HOSPITAL DISTRICT 1418 COLLEGE DR MOUNT CARMEL IL 62863 (618) 262-8621 983 140130 LAKE FOREST HOSPITAL 660 N WESTMORELAND ROAD LAKE FOREST IL 60045 (847) 234-5600 570 140133 HOLY CROSS HOSPITAL 2701 W 68TH STREET CHICAGO IL 60629 (773) 471-8000 141 140135 DECATUR MEMORIAL HOSPITAL 2300 NORTH EDWARD STREET DECATUR IL 62526 (217) 876-8121 660 140137 EDWARD A UTLAUT MEMORIAL HOSPITAL NORTH GRIGG & HIGHWAY 40 GREENVILLE IL 62246 (618) 664-1230 20 140140 ST JOSEPH MEMORIAL HOSPITAL 800 N 2ND ST MURPHYSBORO IL 62966 (618) 684-3156 470 140141 CARLINVILLE AREA HOSPITAL 1001 E MORGAN ST CARLINVILLE IL 62626 (217) 854-3141 670 140143 ST MARGARETS HOSPITAL 600 E 1ST ST SPRING VALLEY IL 61362 (815) 664-5311 50 140144 HARVARD COMMUNITY MEMORIAL HOSPITAL 901 GRANT ST HARVARD IL 60033 (815) 943-5431 640 140145 ST JOSEPHS HOSPITAL JAMESTOWN ROAD BREESE IL 62230 (618) 526-4511 130 140147 RICHLAND MEMORIAL HOSPITAL 800 EAST LOCUST OLNEY IL 62450 (618) 395-2131 880 140148 MEMORIAL MEDICAL CENTER 701 N RUTLEDGE SPRINGFIELD IL 62781 (217) 788-3000 920 140150 UNIVERSITY OF ILLINOIS HOSPITAL 1740 WEST TAYLOR ST SUITE 1400 CHICAGO IL 60612 (312) 996-3900 141 140151 SACRED HEART HOSPITAL 3240 W FRANKLIN BLVD CHICAGO IL 60624 (312) 722-3020 141 140152 BETHANY HOSPITAL 3435 W VAN BUREN CHICAGO IL 60624 (312) 265-7700 141 140155 ST MARYS HOSPITAL 500 W COURT ST KANKAKEE IL 60901 (815) 937-2490 540 140158 MERCY HOSPITAL AND MEDICAL CENTER 2525 S MICHIGAN AVE CHICAGO IL 60616 (312) 567-2000 141 140160 FREEPORT MEMORIAL HOSPITAL 1045 WEST STEPHENSON STREET FREEPORT IL 61032 (815) 235-4131 970 140161 SAINT JAMES HOSPITAL 2500 WEST REYNOLDS STREET PONTIAC IL 61764 (815) 842-2828 610 140162 ST JOSEPH MEDICAL CENTER 2200 E WASHINGTON BLOOMINGTON IL 61701 (309) 662-3311 650 140164 MEMORIAL HOSPITAL 404 W MAIN CARBONDALE IL 62901 (618) 549-0721 470 140165 SALEM TOWNSHIP HOSPITAL 1201 RICKER DRIVE SALEM IL 62881 (618) 548-3194 690 140166 ST MARYS HOSPITAL 1800 E LAKE SHORE DR DECATUR IL 62525 (217) 464-2966 660 140167 IROQUOIS MEMORIAL HOSPITAL 200 FAIRMAN STREET WATSEKA IL 60970 (815) 432-5201 460 140168 ST JOSEPHS HOSPITAL 1515 MAIN STREET HIGHLAND IL 62249 (618) 654-7421 680 140170 UNION COUNTY HOSPITAL 517 N MAIN STREET ANNA IL 62906 (618) 833-4511 981 140171 HAMILTON MEMORIAL HOSPITAL 611 S MARSHALL MCLEANSBORO IL 62859 (618) 643-2361 410 140172 ST JAMES HOSP & HLTH CTR-OLYMPIA FLDS 20201 S CRAWFORD AVENUE OLYMPIA FIELDS IL 60461 (708) 747-4000 141 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 38 Provider ID Hospital Name Address City State ZIP Telephone County 140173 MORRISON COMMUNITY HOSPITAL 303 N JACKSON STREET MORRISON IL 61270 (815) 772-4003 988 140174 MERCY CENTER FOR HEALTH CARE SERVICES 1325 N HIGHLAND AVENUE AURORA IL 60506 (708) 859-2222 530 140176 MEMORIAL MEDICAL CENTER 3701 DOTY ROAD WOODSTOCK IL 60098 (815) 338-2500 640 140177 JACKSON PARK HOSPITAL FOUNDATION 7531 S STONEY ISLAND AVE CHICAGO IL 60649 (312) 947-7500 141 140179 LITTLE COMPANY OF MARY HOSPITAL 2800 W 95TH ST EVERGREEN PARK IL 60805 (708) 422-6200 141 140180 ST MARY OF NAZARETH HOSPITAL CENTER 2233 W DIVISION ST CHICAGO IL 60622 (312) 770-2000 141 140181 SOUTH SHORE HOSPITAL 8012 SOUTH CRANDON AVENUE CHICAGO IL 60617 (773) 768-0810 141 140182 RAVENSWOOD HOSPITAL & MEDICAL CENTER 4550 N WINCHESTER CHICAGO IL 60640 (773) 878-4300 141 140184 MARION MEMORIAL HOSPITAL 917 W MAIN MARION IL 62959 (618) 997-5341 990 140185 MEMORIAL HOSPITAL 4500 MEMORIAL DRIVE BELLEVILLE IL 62223 (618) 233-7750 900 140186 RIVERSIDE MEDICAL CENTER 350 N WALL ST KANKAKEE IL 60901 (815) 933-1671 540 140187 ST ELIZABETH HOSPITAL 211 SOUTH 3RD STREET BELLEVILLE IL 62222 (618) 234-2120 900 140189 SARAH BUSH LINCOLN HEALTH CENTER ROUTE 16 P O BOX 372 MATTOON IL 61938 (217) 258-2572 140 140190 CRAWFORD MEMORIAL HOSPITAL 1000 N ALLEN ROBINSON IL 62454 (618) 544-3131 150 140191 INGALLS MEMORIAL HOSPITAL ONE INGALLS DRIVE HARVEY IL 60426 (708) 333-2300 141 140193 HILLSBORO AREA HOSPITAL 1200 TREMONT ST HILLSBORO IL 62049 (217) 532-6111 760 140197 METHODIST HOSPITAL OF CHICAGO 5025 N PAULINA STREET CHICAGO IL 60640 (312) 271-9040 141 140199 ST FRANCIS HOSPITAL 1215 EAST UNION AVENUE LITCHFIELD IL 62056 (217) 325-2191 760 140200 ELMHURST MEMORIAL HOSPITAL 200 BERTEAU AVE ELMHURST IL 60126 (630) 833-1400 250 140202 CONDELL MEMORIAL HOSPITAL 900 GARFIELD LIBERTYVILLE IL 60048 (708) 362-2900 570 140203 VALLEY WEST COMMUNITY HOSPITAL 11 EAST PLEASANT AVENUE SANDWICH IL 60548 (815) 786-8484 170 140205 NORTHWEST SUBURBAN COMMUNITY HOSPITAL 1625 SO STATE BELVIDERE IL 61008 (815) 547-5441 30 140206 NORWEGIAN-AMERICAN HOSPITAL 1044 N FRANCISCO AVE CHICAGO IL 60622 (773) 292-8200 141 140207 GRANT HOSPITAL 550 W WEBSTER AVE CHICAGO IL 60614 (773) 883-3800 141 140208 EHS CHRIST HOSPITAL & MEDICAL CENTER 4440 W 95TH STREET OAK LAWN IL 60453 (708) 346-5001 141 140209 METHODIST MEDICAL CENTER OF ILLINOIS 221 N E GLEN OAK AVE PEORIA IL 61636 (309) 672-5522 800 140210 HARRISBURG MEDICAL CENTER 17 COUNTRY CLUB COURT HARRISBURG IL 62946 (618) 253-7671 910 140211 DELNOR COMMUNITY HOSPITAL 300 RANDALL RD GENEVA IL 60134 (630) 208-3000 530 140213 SILVER CROSS HOSPITAL 1200 MAPLE RD JOLIET IL 60432 (815) 740-1100 989 140217 ST JOSEPH HOSPITAL 77 N AIRLITE ST ELGIN IL 60120 (708) 695-3200 530 140223 LUTHERAN GENERAL HOSPITAL 1775 DEMPSTER ST PARK RIDGE IL 60068 (847) 723-2210 141 140224 SAINT JOSEPH HOSPITAL & HLTH CR CENTER 2900 NORTH LAKE SHORE DRIVE CHICAGO IL 60657 (312) 975-3000 141 140228 SWEDISH AMERICAN HOSPITAL 1400 CHARLES ST ROCKFORD IL 61108 (815) 968-4400 991 140231 EDWARD HOSPITAL 801 SOUTH WASHINGTON NAPERVILLE IL 60566 (708) 355-0450 250 140233 SAINT ANTHONY MEDICAL CENTER 5666 EAST STATE STREET ROCKFORD IL 61108 (815) 226-2000 991 140234 ILLINOIS VALLEY COMMUNITY HOSPITAL 925 WEST ST PERU IL 61354 (815) 223-3300 580 140239 ROCKFORD MEMORIAL HOSPITAL 2400 NORTH ROCKTON AVENUE ROCKFORD IL 61103 (815) 971-5000 991 140240 WESTLAKE COMMUNITY HOSPITAL 1225 SUPERIOR ST MELROSE PARK IL 60160 (708) 938-4000 141 140242 CENTRAL DUPAGE HOSPITAL 25 NORTH WINFIELD ROAD WINFIELD IL 60190 (630) 682-1600 250 140245 MEMORIAL HOSPITAL 1900 STATE ST CHESTER IL 62233 (618) 826-4581 870 140246 FERRELL HOSPITAL INC 1201 PINE STREET ELDORADO IL 62930 (618) 273-3361 910 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 39 Provider ID Hospital Name Address City State ZIP Telephone County 140250 SOUTH SUBURBAN HOSPITAL 17800 S KEDZIE AVE HAZEL CREST IL 60429 (708) 799-8000 141 140251 OUR LADY OF THE RESURRECTION MED CTR 5645 W ADDISON CHICAGO IL 60634 (312) 282-7000 141 140252 NORTHWEST COMMUNITY HOSPITAL 800 W CENTRAL ROAD ARLINGTON HEIGHTS IL 60005 (708) 259-1000 141 140258 ALEXIAN BROTHERS MEDICAL CENTER 800 W BIESTERFIELD RD ELK GROVE VILLAGE IL 60007 (847) 437-5500 141 140271 PANA COMMUNITY HOSPITAL 101 E NINTH STREET PANA IL 62557 (217) 562-2131 100 140275 ILLINI HOSPITAL 801 HOSPITAL ROAD SILVIS IL 61282 (309) 792-9363 890 140276 LOYOLA UNIVERSITY MEDICAL CENTER 2160 S 1ST ST MAYWOOD IL 60153 (708) 216-9000 141 140280 TRINITY MEDICAL CENTER WEST 2701 17TH ST ROCK ISLAND IL 61201 (309) 779-5000 890 140281 NORTHWESTERN MEMORIAL HOSPITAL 250 E SUPERIOR STREET CHICAGO IL 60611 (312) 908-6754 141 140285 DOCTORS HOSPITAL 5230 SOUTH 6TH STREET SPRINGFIELD IL 62794 (217) 529-7151 920 140286 KISHWAUKEE COMMUNITY HOSPITAL RT 23, 616 BETHANY ROAD DEKALB IL 60115 (815) 756-1521 170 140288 GOOD SAMARITAN HOSPITAL-ADVOCATE 3815 HIGHLAND AVENUE DOWNERS GROVE IL 60515 (708) 963-5900 250 140289 ANDERSON HOSPITAL 6800 STATE ROUTE 162 MARYVILLE IL 62062 (618) 288-5711 680 140290 ST ALEXIUS MEDICAL CENTER 1555 N BARRINGTON RD HOFFMAN ESTATES IL 60194 (847) 843-2000 141 140291 GOOD SHEPHERD HOSPITAL ADVOCATE 450 WEST HIGHWAY 22 BARRINGTON IL 60010 (708) 381-9600 570 140292 GLENOAKS MEDICAL CENTER INC 701 WINTHROP AVENUE GLENDALE HEIGHTS IL 60139 (630) 545-8000 250 140294 CROSSROADS COMMUNITY HOSPITAL 8 DOCTORS PARK ROAD MOUNT VERNON IL 62864 (618) 244-5500 490 140300 PROVIDENT HOSPITAL OF CHICAGO 500 E 51ST ST CHICAGO IL 60615 (312) 572-2000 141 140301 OAK FOREST HOSPITAL 159TH & CICERO AVENUE OAK FOREST IL 60452 (708) 633-2000 141 141300 THOMAS H BOYD MEMORIAL HOSPITAL 800 SCHOOL ST CARROLLTON IL 62016 (217) 942-6946 390 141301 JOHN & MARY KIRBY HOSPITAL 1111 N STATE ST MONTICELLO IL 61856 (217) 762-2115 820 141302 GALENA-STAUSS HOSPITAL 215 SUMMIT ST GALENA IL 61036 (815) 777-1340 510 141303 DR JOHN WARNER HOSPITAL 422 W WHITE ST CLINTON IL 61727 (217) 935-9570 180 141304 MERCER COUNTY HOSPITAL 409 NW 9TH AVENUE ALEDO IL 61231 (309) 582-5301 740 141305 MEMORIAL HOSPITAL SOUTH ADAMS ST, PO BOX 160 CARTHAGE IL 62321 (217) 357-3131 420 141306 COMMUNITY MEMORIAL HOSPITAL 400 CALDWELL STAUNTON IL 62088 (618) 635-2200 670 141307 PINCKNEYVILLE COMMUNITY DIST HOSPITAL 101 N WALNUT PINCKNEYVILLE IL 62274 (618) 357-2187 810 141308 WASHINGTON COUNTY HOSPITAL 705 S GRAND NASHVILLE IL 62263 (618) 327-2264 985 141309 EUREKA COMMUNITY HOSPITAL 101 S MAJOR ST EUREKA IL 61530 (309) 248-2880 992 141310 MENDOTA COMMUNITY HOSPITAL 1315 MEMORIAL DR MENDOTA IL 61342 (815) 539-7461 580 141311 FAIRFIELD MEMORIAL HOSPITAL N W 11TH ST FAIRFIELD IL 62837 (618) 842-2611 986 141312 ROCHELLE COMMUNITY HOSPITAL 900 N 2ND ST ROCHELLE IL 61068 (815) 562-2181 790 141313 MASON DISTRICT HOSPITAL 615 NORTH PROMENADE STREET,P O BOX 5 HAVANA IL 62644 (309) 543-4431 710 141314 CORNERSTONE HEALTHCARE OF IL INC 400 PLUM STREET CARMI IL 62821 (618) 382-4171 987 141315 ILLINI COMMUNITY HOSPITAL 640 W WASHINGTON PITTSFIELD IL 62363 (217) 285-2113 830 141316 HOOPESTON COMMUNITY MEMORIAL HOSPITAL 701 EAST ORANGE STREET HOOPESTON IL 60942 (217) 283-5531 982 141317 GIBSON AREA HOSPITAL 1120 N MELVIN STREET GIBSON CITY IL 60936 (217) 784-4251 350 141318 COMMUNITY MEDICAL CENTER OF WESTERN IL 1000 W HARLEM AVENUE MONMOUTH IL 61462 (309) 734-3141 984 141319 HAMMOND HENRY HOSPITAL 600 N COLLEGE AVENUE GENESEO IL 61254 (309) 944-6431 450 141320 PARIS COMMUNITY HOSPITAL 721 E COURT STREET PARIS IL 61944 (217) 465-4141 982 141321 FRANKLIN HOSPITAL 201 BAILEY LOVE, PO BOX 100 BENTON IL 62812 (618) 439-3161 360 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 40 Provider ID Hospital Name Address City State ZIP Telephone County 141990 HILL TOP CENTER 502 NORTH WAUKEGAN ROAD GREEN OAKS IL 60044 (847) 295-1550 0 142006 VENCOR HOSPITAL SYCAMORE 225 EDWARD STREET SYCAMORE IL 60178 (815) 895-2144 170 142008 THC CHICAGO INC DBA KINDRED HOSP CHGO 365 E NORTH AVE NORTHLAKE IL 60164 (773) 279-2680 141 142009 THC CHICAGO INC DBA KINDRED CHICAGO 4058 W MELROSE CHICAGO IL 60641 (773) 736-7000 141 142010 RML SPECIALTY HOSPITAL 5601 S COUNTY LINE RD HINSDALE IL 60521 (630) 323-5800 250 143025 SCHWAB REHABILITATION CENTER 1401 S CALIFORNIA CHICAGO IL 60608 (312) 522-2010 141 143026 REHABILITATION INSTITUTE OF CHICAGO 345 EAST SUPERIOR CHICAGO IL 60611 (312) 908-6048 141 143027 MARIANJOY REHABILITATION CENTER 26 W171 ROOSEVELT RD P O BOX 795 WHEATON IL 60187 (708) 462-4011 250 143028 VAN MATRE HEALTHSOUTH 950 SO MULFORD ROAD ROCKFORD IL 61108 (815) 381-8500 991 143300 CHILDRENS MEMORIAL HOSPITAL 2300 CHILDRENS PLAZA CHICAGO IL 60614 (312) 880-4010 141 143301 LARABIDA CHILDRENS HOSPITAL E 65TH ST AT LAKE MICHIGAN CHICAGO IL 60649 (773) 363-6700 141 144005 HCA CHICAGO LAKESHORE HOSPITAL 4840 N MARINE DR CHICAGO IL 60640 (312) 878-9700 141 144009 RIVEREDGE HOSPITAL 8311 WEST ROOSEVELT ROAD FOREST PARK IL 60130 (708) 771-7000 141 144010 CHICAGO-READ MENTAL HEALTH CENTER 4200 N OAK PARK AVE CHICAGO IL 60634 (312) 794-4207 141 144016 ALTON MENTAL HEALTH CENTER 4500 COLLEGE AVENUE ALTON IL 62002 (618) 474-3200 0 144019 TINLEY PK MENTAL HEALTH CTR 7400 W 183RD ST TINLEY PARK IL 60477 (708) 614-4002 141 144021 ANDREW MCFARLAND MENTAL HLTH CTR 901 SOUTHWIND RD SPRINGFIELD IL 62703 (217) 786-6900 920 144022 GEORGE A ZELLER MENTAL HLTH CTR 5407 NORTH UNIVERSITY AVE PEORIA IL 61614 (309) 693-5228 800 144023 H DOUGLAS SINGER MENTAL HLTH CTR 4402 N MAIN ST ROCKFORD IL 61103 (815) 987-7096 991 144026 HARTGROVE HOSPITAL 520 N RIDGEWAY CHICAGO IL 60624 (773) 722-2404 141 144028 JOHN J MADDEN MENTAL HEALTH CENTER 1200 S FIRST AVE HINES IL 60141 (708) 531-7202 141 144029 PAVILION FOUNDATION,THE 809 W CHURCH ST CHAMPAIGN IL 61820 (217) 373-1706 90 144030 ROCK CREEK CENTER,THE 40 TIMBERLINE DR LEMONT IL 60439 (630) 257-3636 141 144031 ALEXIAN BROTHERS BEHAVIORAL HLTH HOSP 1650 MOON LAKE BLVD HOFFMAN ESTATES IL 60194 (708) 882-1600 141 144034 BHC STREAMWOOD HOSPITAL INC 1400 E IRVING PARK ROAD STREAMWOOD IL 60107 (708) 837-9000 141 144035 LINDEN OAKS HOSPITAL 801 S WASHINGTON ST NAPERVILLE IL 60540 (708) 305-5500 250 144037 ELGIN MENTAL HEALTH CENTER 750 S STATE ST ELGIN IL 60123 (847) 742-1040 530 144038 CHOATE MENTAL HEALTH & DEVELOPMENT CTR 1000 N MAIN ST ANNA IL 62906 (618) 833-5161 981 150001 JOHNSON MEMORIAL HOSPITAL 1125 WEST JEFFERSON ST FRANKLIN IN 46131 (317) 736-3300 400 150002 METHODIST HOSPITALS NORTHLAKE 600 GRANT ST GARY IN 46402 (219) 886-4601 440 150003 ST ELIZABETH MEDICAL CENTER 1501 HARTFORD STREET LAFAYETTE IN 47904 (765) 423-6011 780 150004 ST MARGARET MERCY HLTHCARE CTRS-NO CAM 5454 HOHMAN AVENUE HAMMOND IN 46320 (219) 932-2300 440 150005 HENDRICKS COMMUNITY HOSPITAL 1000 EAST MAIN STREET DANVILLE IN 46122 (317) 745-3500 310 150006 LA PORTE HOSPITAL AND HEALTH SERVICES 1007 LINCOLNWAY LA PORTE IN 46350 (219) 326-1234 450 150007 HOWARD COMMUNITY HOSPITAL 3500 S LA FOUNTAIN ST KOKOMO IN 46902 (765) 453-0702 330 150008 ST CATHERINE HOSPITAL INC 4321 FIR ST EAST CHICAGO IN 46312 (219) 392-1700 440 150009 CLARK MEMORIAL HOSPITAL 1220 MISSOURI AVENUE JEFFERSONVILLE IN 47130 (812) 283-6631 90 150010 ST JOSEPH HOSPITAL & HEALTH CENTER 1907 WEST SYCAMORE STREET KOKOMO IN 46901 (765) 452-5611 330 150011 MARION GENERAL HOSPITAL 441 NORTH WABASH AVENUE MARION IN 46952 (765) 662-1441 260 150012 SAINT JOSEPH'S REGIONAL MEDICAL CTR 801 E LASALLE ST SOUTH BEND IN 46617 (574) 237-7111 700 150013 SULLIVAN COUNTY COMMUNITY HOSPITAL 2200 NORTH SECTION ST SULLIVAN IN 47882 (812) 268-4311 760 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 41 Provider ID Hospital Name Address City State ZIP Telephone County 150014 WINONA MEMORIAL HOSPITAL 3232 NORTH MERIDIAN STREET INDIANAPOLIS IN 46208 (317) 924-3392 480 150015 ST ANTHONY MEMORIAL HEALTH CENTERS 301 W HOMER ST MICHIGAN CITY IN 46360 (219) 879-8511 450 150017 LUTHERAN HOSPITAL OF INDIANA 7950 WEST JEFFERSON BLVD FORT WAYNE IN 46804 (260) 435-7001 10 150018 ELKHART GENERAL HOSPITAL 600 EAST BOULEVARD ELKHART IN 46514 (574) 523-3254 190 150019 DEACONESS ST JOSEPH'S HOSPITAL 1900 MEDICAL ARTS DRIVE HUNTINGBURG IN 47542 (812) 683-2121 180 150020 GIBSON GENERAL HOSPITAL 1808 SHERMAN DRIVE PRINCETON IN 47670 (812) 385-3401 250 150021 PARKVIEW HOSPITAL 2200 RANDALIA DRIVE FORT WAYNE IN 46805 (260) 373-3601 10 150022 ST CLARE MEDICAL CENTER 1710 LAFAYETTE RD CRAWFORDSVILLE IN 47933 (765) 364-3100 530 150023 UNION HOSPITAL INC 1606 NORTH 7TH STREET TERRE HAUTE IN 47804 (812) 238-7000 830 150024 WILLIAM N WISHARD MEMORIAL HOSPITAL 1001 WEST 10TH STREET INDIANAPOLIS IN 46202 (317) 630-7356 480 150026 GOSHEN GENERAL HOSPITAL 200 HIGH PARK AVENUE GOSHEN IN 46526 (574) 535-2666 190 150027 PUTNAM COUNTY HOSPITAL 1542 BLOOMINGTON ST GREENCASTLE IN 46135 (765) 653-5121 660 150029 ST JOSEPH COMMUNITY HOSPITAL 215 W 4TH ST MISHAWAKA IN 46544 (574) 259-2431 700 150030 HENRY COUNTY MEMORIAL HOSPITAL 1000 NORTH 16TH STREET NEW CASTLE IN 47362 (765) 521-0890 320 150031 JAY COUNTY HOSPITAL 500 W VOTAW ST PORTLAND IN 47371 (260) 726-7131 370 150033 ST FRANCIS HOSPITAL & HEALTH CENTERS 1600 ALBANY STREET BEECH GROVE IN 46107 (317) 787-3311 480 150034 ST MARY MEDICAL CENTER INC 1500 S LAKE PARK AVE HOBART IN 46342 (219) 942-0551 440 150035 PORTER MEMORIAL HOSPITAL 814 LAPORTE AVE VALPARAISO IN 46383 (219) 465-4600 630 150037 HANCOCK MEMORIAL HOSPITAL & HEALTH 801 NORTH STATE STREET, PO BOX 827 GREENFIELD IN 46140 (317) 468-4412 290 150038 MORGAN HOSPITAL AND MEDICAL CENTER 2209 JOHN R WOODEN DR MARTINSVILLE IN 46151 (765) 349-6502 540 150039 CAMERON MEMORIAL COMMUNITY HOSPITAL 416 EAST MAUMEE STREET ANGOLA IN 46703 (260) 665-2141 750 150042 GOOD SAMARITAN HOSPITAL 520 SOUTH 7TH STREET VINCENNES IN 47591 (812) 882-5220 410 150043 ST VINCENT FRANKFORT HOSPITAL INC 1300 S JACKSON ST FRANKFORT IN 46041 (765) 659-4731 110 150044 FLOYD MEMORIAL HOSPITAL & HEALTH SERV 1850 STATE STREET NEW ALBANY IN 47150 (812) 949-5500 210 150045 DEKALB MEMORIAL HOSPITAL INC 1316 EAST SEVENTH STREET AUBURN IN 46706 (260) 925-4600 160 150046 TERRE HAUTE REGIONAL HOSPITAL 3901 S 7TH ST TERRE HAUTE IN 47802 (812) 232-0021 830 150047 ST JOSEPH HOSPITAL 700 BROADWAY FORT WAYNE IN 46802 (260) 425-3000 10 150048 REID HOSPITAL & HEALTH CARE SERVICES 1401 CHESTER BOULEVARD RICHMOND IN 47374 (765) 983-3000 880 150049 DUNN MEMORIAL HOSPITAL 1600 23RD STREET BEDFORD IN 47421 (812) 275-3331 460 150051 BLOOMINGTON HOSPITAL & HEALTHCARE SYS 601 W SECOND ST BLOOMINGTON IN 47402 (812) 353-9555 520 150052 SCOTT CO MEMORIAL HOSPITAL 1451 N GARDNER ST SCOTTSBURG IN 47170 (812) 752-8500 710 150056 CLARIAN HEALTH PARTNERS INC 1701 N SENATE BOULEVARD INDIANAPOLIS IN 46202 (317) 962-6168 480 150057 ST FRANCIS HOSPITAL AND HEALTH CENTERS 1201 HADLEY ROAD MOORESVILLE IN 46158 (317) 831-1160 540 150058 MEMORIAL HOSPITAL OF SOUTH BEND 615 N MICHIGAN ST SOUTH BEND IN 46601 (574) 234-9041 700 150059 RIVERVIEW HOSPITAL 395 WESTFIELD RD NOBLESVILLE IN 46060 (317) 776-7106 280 150060 WEST CENTRAL COMMUNITY HOSPITAL 801 SOUTH MAIN STREET CLINTON IN 47842 (765) 832-1203 820 150061 DAVIESS COMMUNITY HOSPITAL 1314 E WALNUT ST P O BOX 760 WASHINGTON IN 47501 (812) 254-2760 130 150062 DECATUR COUNTY MEMORIAL HOSPITAL 720 NORTH LINCOLN STREET GREENSBURG IN 47240 (812) 663-4331 150 150064 FAYETTE MEMORIAL HOSPITAL ASSOC INC 1941 VIRGINIA AVE CONNERSVILLE IN 47331 (765) 825-5131 200 150065 MEMORIAL HOSPITAL 411 WEST TIPTON STREET SEYMOUR IN 47274 (812) 524-4237 350 150066 GREENE COUNTY GENERAL HOSPITAL RR 1 BOX 1000 LINTON IN 47441 (812) 847-2281 270 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 42 Provider ID Hospital Name Address City State ZIP Telephone County 150067 DUKES MEMORIAL HOSPITAL 275 W 12TH ST PERU IN 46970 (765) 472-8000 510 150069 KING'S DAUGHTERS HOSPITAL & HEALTH SVC ONE KING'S DAUGHTERS' DRIVE MADISON IN 47250 (812) 265-0105 380 150070 PERRY COUNTY MEMORIAL HOSPITAL ONE HOSPITAL ROAD TELL CITY IN 47586 (812) 547-7011 610 150072 MEMORIAL HOSPITAL 1101 MICHIGAN AVE LOGANSPORT IN 46947 (574) 753-7541 80 150074 COMMUNITY HOSPITAL OF INDIANA INC 1500 N RITTER AVENUE INDIANAPOLIS IN 46219 (317) 355-5411 480 150075 BLUFFTON REGIONAL MEDICAL CENTER 303 SOUTH MAIN STRET BLUFFTON IN 46714 (260) 824-3210 890 150076 SAINT JOSEPH'S REGIONAL MEDICAL CENTER 1915 LAKE AVE PLYMOUTH IN 46563 (574) 936-3181 490 150078 JASPER COUNTY HOSPITAL 1104 EAST GRACE STREET RENSSELAER IN 47978 (219) 866-5141 360 150079 HARRISON COUNTY HOSPITAL 245 ATWOOD STREET CORYDON IN 47112 (812) 738-4251 300 150082 DEACONESS HOSPITAL INC 600 MARY STREET EVANSVILLE IN 47747 (812) 450-5000 810 150084 ST VINCENT HOSPITAL & HEALTH SERVICES 2001 WEST 86TH STREET INDIANAPOLIS IN 46260 (317) 338-7000 480 150086 DEARBORN COUNTY HOSPITAL 600 WILSON CREEK RD LAWRENCEBURG IN 47025 (812) 537-1010 140 150088 SAINT JOHNS HEALTH SYSTEM 2015 JACKSON ST ANDERSON IN 46016 (765) 649-2511 470 150089 BALL MEMORIAL HOSPITAL INC 2401 UNIVERSITY AVENUE MUNCIE IN 47303 (765) 747-3251 170 150090 ST MARGARET MERCY HLTHCARE CTRS INC SC 24 JOLIET STREET DYER IN 46311 (219) 865-2141 440 150091 HUNTINGTON MEMORIAL HOSPITAL INC 2001 STULTZ RD HUNTINGTON IN 46750 (260) 355-3000 340 150096 LAGRANGE COMMUNITY HOSPITAL 207 NORTH TOWNLINE RD LAGRANGE IN 46761 (260) 463-2143 430 150097 MAJOR HOSPITAL 150 WEST WASHINGTON STREET SHELBYVILLE IN 46176 (317) 398-5252 720 150098 WASHINGTON COUNTY MEMORIAL HOSPITAL 911 N SHELBY ST SALEM IN 47167 (812) 883-5881 870 150100 ST MARY'S HEALTH CARE SERVICES 3700 WASHINGTON AVE EVANSVILLE IN 47750 (812) 485-4000 810 150101 PARKVIEW WHITLEY HOSPITAL 353 N OAK ST COLUMBIA CITY IN 46725 (260) 248-9000 910 150102 STARKE MEMORIAL HOSPITAL 102 EAST CULVER ROAD KNOX IN 46534 (574) 772-6231 740 150104 WITHAM MEMORIAL HOSPITAL 1124 NORTH LEBANON STREET LEBANON IN 46052 (765) 482-2700 50 150106 ADAMS COUNTY MEMORIAL HOSPITAL 805 HIGH STREET DECATUR IN 46733 (260) 724-2145 0 150109 LAFAYETTE HOME HOSPITAL 2400 SOUTH ST LAFAYETTE IN 47904 (765) 447-6811 780 150111 WOODLAWN HOSPITAL 1400 EAST 9TH ST ROCHESTER IN 46975 (219) 224-1173 240 150112 COLUMBUS REGIONAL HOSPITAL 2400 EAST 17TH STREET COLUMBUS IN 47201 (812) 379-4441 20 150113 COMMUNITY HOSPITAL ANDERSON & MADSN CO 1515 N MADISON AV ANDERSON IN 46011 (765) 298-5120 470 150115 MEMORIAL HOSPITAL & HLTH CARE CENTER 800 W 9TH ST JASPER IN 47546 (812) 482-2345 180 150122 MARGARET MARY COMMUNITY HOSPITAL 321 MITCHEL AVENUE BATESVILLE IN 47006 (812) 934-6624 230 150123 WIRTH REGIONAL HOSPITAL HWY 64 WEST RR 3 BOX 14A OAKLAND CITY IN 47660 (812) 749-6111 250 150124 BEDFORD REGIONAL MEDICAL CENTER 2900 WEST 16TH STREET BEDFORD IN 47421 (812) 275-1200 460 150125 COMMUNITY HOSPITAL 901 MACARTHUR BOULEVARD MUNSTER IN 46321 (219) 836-1600 440 150126 ST ANTHONY MEDICAL CENTER 1201 SOUTH MAIN STREET CROWN POINT IN 46307 (219) 757-6107 440 150128 COMMUNITY HOSPITAL SOUTH 1402 E SOUTH COUNTY LINE ROAD INDIANAPOLIS IN 46227 (317) 887-7000 480 150129 WESTVIEW HOSPITAL 3630 GUION RD INDIANAPOLIS IN 46222 (317) 924-6661 480 150130 ST MARY'S WARRICK 1116 MILLIS AVE P O BOX 629 BOONVILLE IN 47601 (812) 897-4800 860 150132 METHODIST HOSPITALS INC SOUTHLAKE 8701 BROADWAY MERRILLVILLE IN 46410 (219) 886-4601 440 150133 KOSCIUSKO COMMUNITY HOSPITAL 2101 EAST DUBOIS DRIVE WARSAW IN 46580 (574) 267-3200 420 150134 MEDICAL CENTER OF SOUTHERN INDIANA 2200 MARKET ST CHARLESTOWN IN 47111 (812) 256-3301 90 150136 WOMEN'S HOSPITAL OF INDIANAPOLIS 8111 TOWNSHIP LINE ROAD INDIANAPOLIS IN 46260 (317) 875-5994 480 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 43 Provider ID Hospital Name Address City State ZIP Telephone County 150146 PARKVIEW NOBLE HOSPITAL 951 EAST HOSPITAL DRIVE KENDALLVILLE IN 46755 (219) 347-6344 560 150147 ILLIANA SURGERY AND MEDICAL CENTER LLC 701 SUPERIOR AVE MUNSTER IN 46321 (219) 924-1300 440 150149 WOMEN'S HOSPITAL,THE 4199 GATEWAY BLVD NEWBURGH IN 47630 (812) 842-4222 860 150150 DUPONT HOSPITAL LLC 2520 E DUPONT RD FORT WAYNE IN 46825 (260) 416-3000 10 150151 SELECT SPECIALTY HOSPITAL-BLOOMINGTON 601 W SECOND STREET, 4TH FLOOR BLOOMINGTON IN 47402 (812) 353-2000 20 151300 COMMUNITY HOSPITAL OF BREMEN INC 411 S WHITLOCK ST BREMEN IN 46506 (574) 546-2211 490 151301 ST VINCENT RANDOLPH HOSPITAL INC 325 S OAK ST WINCHESTER IN 47394 (765) 584-9001 670 151302 BLACKFORD COMMUNITY HOSPITAL 503 E VANCLEVE ST HARTFORD CITY IN 47348 (765) 348-0300 40 151303 ST VINCENT JENNINGS COMMUNITY HOSP INC 301 HENRY ST NORTH VERNON IN 47265 (812) 352-4200 390 151304 RUSH MEMORIAL HOSPITAL 1300 N MAIN ST RUSHVILLE IN 46173 (765) 932-4111 690 151305 PULASKI MEMORIAL HOSPITAL 616 EAST 13TH STREET WINAMAC IN 46996 (574) 946-2160 650 151306 BLOOMINGTON HOSPITAL OF ORANGE COUNTY 642 W HOSPITAL ROAD PAOLI IN 47454 (812) 723-2811 580 151307 ST VINCENT WILLIAMSPORT HOSPITAL, INC 412 N MONROE STREET WILLIAMSPORT IN 47993 (765) 762-4000 850 151308 ST VINCENT MERCY HOSPITAL, INC 1331 SOUTH A STREET ELWOOD IN 46036 (765) 552-4600 470 151309 ST VINCENT CLAY HOSPITAL INC 1206 EAST NATIONAL AVENUE BRAZIL IN 47834 (812) 448-2675 100 151310 WABASH COUNTY HOSPITAL 710 N EAST STREET WABASH IN 46992 (219) 563-3131 840 151311 TIPTON COUNTY MEMORIAL HOSPITAL 1000 S MAIN STREET TIPTON IN 46072 (765) 675-8500 790 151312 WHITE COUNTY MEMORIAL HOSPITAL 1101 O'CONNOR BOULEVARD MONTICELLO IN 47960 (574) 583-7111 900 152005 MADISON STATE HOSPITAL STATE ROAD 7 NORTH MADISON IN 47250 (812) 265-2611 380 152007 KINDRED HOSPITAL INDIANAPOLIS 1700 W 10TH ST INDIANAPOLIS IN 46222 (317) 636-4400 480 152008 KINDRED HOSPITAL INDIANAPOLIS SOUTH 898 E MAIN ST GREENWOOD IN 46143 (317) 888-8155 400 152010 SELECT SPECIALTY HOSPITAL INDIANAPOLIS I 65 AT 21ST STREET BLDG C 7&8 INDIANAPOLIS IN 46202 (317) 931-1676 480 152011 ST ELIZABETH ANN SETON HOSPITAL INC 3700 WASHINGTON AVE EVANSVILLE IN 47750 (812) 485-5441 260 152012 SELECT SPECIALTY HOSPITAL-NORTHWEST IN 5454 HOHMAN AVE, 5TH FL HAMMOND IN 46320 (219) 937-9900 440 152013 SELECT SPECIALTY HOSPITAL-BEECH GROVE 1600 ALBANY STREET SUITE 200 BEECH GROVE IN 46107 (317) 783-8913 480 152014 SELECT SPECIALTY HOSPITAL-EVANSVILLE 600 MARY ST, SUITE 3325 EVANSVILLE IN 47747 (812) 450-5270 810 152015 ST ELIZABETH ANN SETON HOSPITAL OF CEN 13500 N MERIDIAN, 2ND FLOOR CARMEL IN 46032 (317) 582-8500 280 152016 SELECT SPECIALTY HOSPITAL-FT WAYNE 700 BROADWAY FORT WAYNE IN 46802 (260) 425-3810 10 152017 SCCI HOSPITAL OF KOKOMO 1907 W SYCAMORE KOKOMO IN 46901 (765) 452-6730 330 152018 OUR LADY OF PEACE HOSPITAL 801 E LASALLE AVE SOUTH BEND IN 46617 (574) 280-5822 700 153025 HEALTHSOUTH TRI-STATE REHAB HOSPITAL 4100 COVERT AVE EVANSVILLE IN 47716 (812) 476-9983 810 153027 HEALTHSOUTH REHABILITATION HOSP OF KOK 829 N DIXON RD KOKOMO IN 46901 (765) 452-6700 330 153028 REHABILITATION HOSPITAL OF INDIANA 4141 SHORE DR INDIANAPOLIS IN 46254 (317) 329-2106 480 153029 HEALTHSOUTH REHABILITATION HOSPITAL 501 ST ANTHONY DR TERRE HAUTE IN 47802 (812) 235-1392 830 153030 REHABILITATION HOSPITAL OF FT WAYNE 7970 W JEFFERSON BLVD FORT WAYNE IN 46804 (260) 436-2644 10 153037 SOUTHERN INDIANA REHAB HOSPITAL 3104 BLACKISTON BLVD NEW ALBANY IN 47150 (812) 941-8300 210 153300 ST VINCENT CHILDREN'S SPECIALITY HOSPI 1707 W 86TH ST INDIANAPOLIS IN 46260 (317) 415-5500 480 154005 WABASH VALLEY HOSPITAL INC 2900 NORTH RIVER ROAD WEST LAFAYETTE IN 47906 (765) 463-2555 780 154008 LARUE D CARTER MEM HOSP 2601 COLD SPRING RD INDIANAPOLIS IN 46222 (317) 634-8401 480 154009 HAMILTON CENTER INC 620 8TH AVE TERRE HAUTE IN 47804 (812) 231-8323 830 154011 COMMUNITY MENTAL HEALTH CENTER INC 285 BIELBY ROAD LAWRENCEBURG IN 47025 (812) 537-1302 140 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 44 Provider ID Hospital Name Address City State ZIP Telephone County 154014 OTIS R BOWEN CTR FOR HUMAN SVS INC 850 N HARRISON ST WARSAW IN 46581 (574) 267-7169 420 154018 RICHMOND STATE HOSPITAL 498 NORTH WEST 18TH STREET RICHMOND IN 47374 (765) 966-0511 880 154019 MADISON STATE HOSP STATE RD 7 N MADISON IN 47250 (812) 265-2611 380 154020 SOUTHLAKE CENTER FOR MENTAL HEALTH INC 8555 TAFT STREET MERRILLVILLE IN 46410 (219) 769-4005 440 154021 GRANT-BLACKFORD MENTAL HEALTH, INC 505 WABASH AVENUE MARION IN 46952 (765) 662-3971 260 154024 BHC VALLE VISTA HOSPITAL 898 EAST MAIN STREET GREENWOOD IN 46143 (317) 887-1348 400 154031 OAKLAWN PSYCHIATRIC CENTER, INC 330 LAKEVIEW DRIVE GOSHEN IN 46527 (574) 533-1234 190 154034 FAIRBANKS HOSPITAL INC 8102 CLEARVISTA PARKWAY INDIANAPOLIS IN 46256 (317) 849-8222 480 154035 FOUR COUNTY COUNSELING CENTER 1015 MICHIGAN AVE LOGANSPORT IN 46947 (574) 722-5151 80 154040 MADISON HOSPITAL CORPORATION 403 E MADISON ST SOUTH BEND IN 46617 (574) 234-0061 700 154041 MEADOWS HOSPITAL,THE 3600 N PROW RD BLOOMINGTON IN 47404 (812) 331-8000 520 154042 DEACONESS CROSS POINTE CENTER LLC 7200 E INDIANA EVANSVILLE IN 47715 (812) 476-7200 810 154047 BEHAVIORAL HEALTHCARE OF NORTHERN IN 1800 N OAK RD PLYMOUTH IN 46563 (574) 936-3784 490 154048 BEHAVIORAL HEALTHCARE COLUMBUS 2223 POSHARD DR COLUMBUS IN 47202 (812) 376-1711 20 154049 RIVERSIDE HOSPITAL CORPORATION 533 N NILES AVE SOUTH BEND IN 46617 (574) 283-1104 700 160001 MARSHALLTOWN MEDICAL & SURGICAL CENTER THREE SOUTH FOURTH AVENUE MARSHALLTOWN IA 50158 (641) 754-5145 630 160002 AVERA HOLY FAMILY HOSPITAL 826 NORTH EIGHTH STREET ESTHERVILLE IA 51334 (712) 362-2631 310 160003 SIOUX VALLEY MEMORIAL HOSPITAL 300 SIOUX VALLEY DRIVE CHEROKEE IA 51012 (712) 225-5101 170 160005 ST ANTHONY REGIONAL HOSPITAL 311 SOUTH CLARK STREET CARROLL IA 51401 (712) 792-3581 130 160008 KEOKUK AREA HOSPITAL 1600 MORGAN STREET KEOKUK IA 52632 (319) 524-7150 550 160012 WASHINGTON COUNTY HOSPITAL 400 EAST POLK STREET WASHINGTON IA 52353 (319) 653-5481 910 160013 UNITY HOSPITAL 1518 MULBERRY AVENUE MUSCATINE IA 52761 (319) 264-9100 690 160014 CRAWFORD COUNTY MEMORIAL HOSPITAL 2020 FIRST AVE SOUTH DENISON IA 51442 (712) 263-5021 230 160016 TRINITY REGIONAL MEDICAL CENTER SOUTH KENYON ROAD FORT DODGE IA 50501 (515) 573-3101 930 160020 MERCY MEDICAL CENTER-CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 (641) 437-3411 30 160024 IOWA LUTHERAN HOSPITAL 700 EAST UNIVERSITY AVENUE DES MOINES IA 50316 (515) 263-5230 760 160026 BOONE COUNTY HOSPITAL 1015 UNION STREET BOONE IA 50036 (515) 432-3140 90 160028 ALEGENT HEALTH MERCY HOSPITAL 800 MERCY DR BOX 1-C COUNCIL BLUFFS IA 51502 (712) 328-5000 770 160029 MERCY HOSPITAL 500 MARKET STREET IOWA CITY IA 52240 (319) 339-0300 510 160030 MARY GREELEY MEDICAL CENTER 1111 DUFF AVENUE AMES IA 50010 (515) 239-2011 840 160031 SHELBY COUNTY MYRTUE MEMORIAL HOSPITAL 1213 GARFIELD AVENUE HARLAN IA 51537 (712) 755-5161 820 160032 SKIFF MEDICAL CENTER 204 NORTH FOURTH AVENUE EAST NEWTON IA 50208 (641) 792-1273 490 160033 GENESIS MEDICAL CENTER 1227 EAST RUSHOLME STREET DAVENPORT IA 52803 (563) 421-6510 810 160034 ELLSWORTH MUNICIPAL HOSPITAL 110 ROCKSYLVANIA AVENUE IOWA FALLS IA 50126 (641) 648-4631 410 160037 FLOYD COUNTY MEMORIAL HOSPITAL 800 11TH STREET CHARLES CITY IA 50616 (641) 228-6830 330 160039 CASS COUNTY MEMORIAL HOSPITAL 1501 EAST TENTH STREET ATLANTIC IA 50022 (712) 243-3250 140 160040 SARTORI MEMORIAL HOSPITAL W 6TH & COLLEGE CEDAR FALLS IA 50613 (319) 268-3000 60 160043 CLARINDA REGIONAL HEALTH CENTER 17TH & WELLS PO BOX 217 CLARINDA IA 51632 (712) 542-2176 720 160044 PELLA REGIONAL HEALTH CENTER 404 JEFFERSON STREET PELLA IA 50219 (641) 628-3150 620 160045 ST LUKES HOSPITAL 1026 A AVE NE CEDAR RAPIDS IA 52402 (319) 369-7211 560 160047 JENNIE EDMUNDSON HOSPITAL 933 EAST PIERCE STREET COUNCIL BLUFFS IA 51502 (712) 328-6000 770 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 45 Provider ID Hospital Name Address City State ZIP Telephone County 160048 RINGGOLD COUNTY HOSPITAL 211 SHELLWAY DRIVE MOUNT AYR IA 50854 (515) 464-3226 790 160049 CLARKE COUNTY PUBLIC HOSPITAL 800 SOUTH FILLMORE STREET OSCEOLA IA 50213 (641) 342-2184 190 160050 MAHASKA COUNTY HOSPITAL 1229 C AVENUE EAST OSKALOOSA IA 52577 (515) 672-3100 610 160057 GREAT RIVER MEDICAL CENTER 1221 SOUTH GEAR AVENUE WEST BURLINGTON IA 52655 (319) 768-3601 280 160058 UNIVERSITY OF IOWA HOSPITAL & CLINIC 200 HAWKINS DRIVE IOWA CITY IA 52242 (319) 356-1616 530 160064 MERCY MEDICAL CENTER-NORTH IOWA 1000 FOURTH STREET SW MASON CITY IA 50401 (641) 422-7000 160 160066 BUENA VISTA REGIONAL MEDICAL CENTER 1525 WEST FIFTH STREET STORM LAKE IA 50588 (712) 732-4030 100 160067 COVENANT MEDICAL CENTER 3421 WEST NINTH STREET WATERLOO IA 50702 (319) 272-8000 60 160069 MERCY MEDICAL CENTER-DUBUQUE 250 MERCY DRIVE DUBUQUE IA 52001 (563) 589-8000 300 160072 STEWART MEMORIAL COMMUNITY HOSPITAL 1301 WEST MAIN ST LAKE CITY IA 51449 (712) 464-3171 120 160074 ORANGE CITY MUNICIPAL HOSPITAL 400 CENTRAL AVENUE NW ORANGE CITY IA 51041 (712) 737-4984 830 160076 HAMILTON COUNTY PUBLIC HOSPITAL 800 OHIO STREET BOX 430 WEBSTER CITY IA 50595 (515) 832-9400 390 160079 MERCY MEDICAL CENTER 701 10TH ST SE CEDAR RAPIDS IA 52403 (319) 398-6217 560 160080 MERCY MEDICAL CENTER - CLINTON 638 S BLUFF BLVD CLINTON IA 52732 (319) 244-5555 220 160081 WINNESHIEK COUNTY MEMORIAL HOSPITAL 901 MONTGOMERY STREET DECORAH IA 52101 (319) 382-2911 950 160082 IOWA METHODIST MEDICAL CENTER 1200 PLEASANT STREET DES MOINES IA 50309 (515) 241-6201 760 160083 MERCY MEDICAL CENTER/MERCY CAPITOL 400 UNIVERSITY AVENUE DES MOINES IA 50314 (515) 247-3121 760 160089 OTTUMWA REGIONAL HEALTH CENTER 1001 E PENNSYLVANIA OTTUMWA IA 52501 (515) 682-7511 890 160090 MONTGOMERY COUNTY MEMORIAL HOSPITAL 1201 HIGHLAND AVENUE RED OAK IA 51566 (712) 623-7000 680 160091 LORING HOSPITAL 211 HIGHLAND AVENUE SAC CITY IA 50583 (712) 662-7105 800 160092 SHENANDOAH MEMORIAL HOSPITAL 300 PERSHING AVENUE SHENANDOAH IA 51601 (712) 246-1230 720 160093 VIRGINIA GAY HOSPITAL 502 NORTH NINTH AVENUE VINTON IA 52349 (319) 472-6200 50 160101 BROADLAWNS MEDICAL CENTER 1801 HICKMAN ROAD DES MOINES IA 50314 (515) 282-2200 760 160104 TRINITY MEDICAL CENTER NORTH 1111 WEST KIMBERLY ROAD DAVENPORT IA 52806 (563) 445-4020 810 160106 HENRY COUNTY HEALTH CENTER 407 SOUTH WHITE ST MOUNT PLEASANT IA 52641 (319) 385-3141 430 160107 BURGESS HEALTH CENTER 1600 DIAMOND AVENUE ONAWA IA 51040 (712) 423-2311 660 160109 SIOUX CTR COMM HOSPITAL & HEALTH CTR 605 SOUTH MAIN STREET SIOUX CENTER IA 51250 (712) 722-1271 830 160110 ALLEN MEMORIAL HOSPITAL 1825 LOGAN AVENUE WATERLOO IA 50703 (319) 235-3941 60 160112 SPENCER MUNICIPAL HOSPITAL 114 EAST 12TH STREET SPENCER IA 51301 (712) 264-6198 200 160113 WAYNE COUNTY HOSPITAL 417 SOUTH EAST STREET CORYDON IA 50060 (641) 872-2260 920 160114 KNOXVILLE AREA COMMUNITY HOSPITAL 1002 SOUTH LINCOLN KNOXVILLE IA 50138 (641) 842-2151 620 160115 JEFFERSON COUNTY HOSPITAL 400 HIGHLAND FAIRFIELD IA 52556 (515) 472-4111 500 160116 GREATER COMMUNITY HOSPITAL 1700 WEST TOWNLINE ROAD CRESTON IA 50801 (641) 782-7091 870 160117 FINLEY HOSPITAL 350 NORTH GRANDVIEW DUBUQUE IA 52001 (563) 582-1881 300 160118 PALO ALTO COUNTY HOSPITAL 3201 FIRST STREET EMMETSBURG IA 50536 (712) 852-2434 730 160122 FORT MADISON COMMUNITY HOSPITAL 5445 AVENUE O BOX 174 FORT MADISON IA 52627 (319) 372-6530 550 160124 DICKINSON COUNTY MEMORIAL HOSPITAL HWY 71 SOUTH BOX AB SPIRIT LAKE IA 51360 (712) 336-1230 290 160126 NORTHWEST IOWA HEALTH CENTER 118 NORTH SEVENTH AVENUE SHELDON IA 51201 (712) 324-5041 700 160130 OSCEOLA COMMUNITY HOSPITAL 9TH AVENUE NORTH SIBLEY IA 51249 (712) 754-2574 710 160131 HORN MEMORIAL HOSPITAL 701 EAST 2ND STREET IDA GROVE IA 51445 (712) 364-3311 460 160135 MERCY HOSPITAL OF FRANCISCAN SISTERS 201 EIGHTH AVENUE SE OELWEIN IA 50662 (319) 283-6000 320 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 46 Provider ID Hospital Name Address City State ZIP Telephone County 160140 FLOYD VALLEY HOSPITAL 714 LINCOLN ST LE MARS IA 51031 (712) 546-7871 740 160143 KOSSUTH REGIONAL HEALTH CENTER 1515 PHILLIPS ALGONA IA 50511 (515) 295-2451 540 160146 ST LUKES REGIONAL MEDICAL CENTER 2720 STONE PARK BOULEVARD SIOUX CITY IA 51104 (712) 279-3500 960 160147 GRINNELL REGIONAL MEDICAL CENTER 210 FOURTH AVENUE GRINNELL IA 50112 (641) 236-7511 780 160153 MERCY MEDICAL CENTER-SIOUX CITY 801 5TH ST BOX #316B SIOUX CITY IA 51101 (712) 279-2010 960 161300 BAUM-HARMON MEMORIAL HOSPITAL 255 N WELCH AVENUE PRIMGHAR IA 51245 (712) 757-2300 700 161301 BELMOND MEDICAL CENTER 403 SECOND STREET SE BELMOND IA 50421 (641) 444-3223 980 161302 WRIGHT MEDICAL CENTER 1316 SOUTH MAIN STREET CLARION IA 50525 (515) 532-2811 980 161303 GRUNDY COUNTY MEMORIAL HOSPITAL 201 EAST J AVENUE GRUNDY CENTER IA 50638 (319) 824-5421 470 161304 ALEGENT HEALTH MERCY HOSPITAL 603 ROSARY DRIVE CORNING IA 50841 (641) 322-3121 10 161305 POCAHONTAS COMMUNITY HOSPITAL 606 NW 7TH STREET POCAHONTAS IA 50574 (712) 335-3501 750 161306 JONES REGIONAL MEDICAL CENTER 104 BROADWAY PLACE ANAMOSA IA 52205 (319) 462-6131 520 161307 HANCOCK COUNTY MEMORIAL HOSPITAL 532 FIRST STREET NW BRITT IA 50423 (641) 843-3801 400 161308 FRANKLIN GENERAL HOSPITAL 1720 CENTRAL AVENUE EAST HAMPTON IA 50441 (641) 456-5000 340 161309 ALLEGENT HEALTH COMMUNITY MEMORIAL 631 NORTH EIGHTH STREET MISSOURI VALLEY IA 51555 (712) 642-2784 420 161310 ADAIR COUNTY MEMORIAL HOSPITAL 609 SE KENT GREENFIELD IA 50849 (641) 743-2123 20 161311 HAWARDEN COMMUNITY HOSPITAL 1111 11TH STREET HAWARDEN IA 51023 (712) 551-3100 830 161312 GUTTENBERG MUNICIPAL HOSPITAL 2ND AND MAIN PO BOX 550 GUTTENBERG IA 52052 (563) 252-1121 210 161313 DEWITT COMMUNITY HOSPITAL 1118 11TH STREET DEWITT IA 52742 (563) 659-4200 220 161314 GUTHRIE COUNTY HOSPITAL 710 NORTH 12TH STREET GUTHRIE CENTER IA 50115 (641) 747-2201 380 161315 KEOKUK COUNTY HEALTH CENTER 1312 SOUTH STUART STREET SIGOURNEY IA 52591 (641) 622-2720 530 161316 PALMER LUTHERAN HEALTH CENTER 112 JEFFERSON STREET WEST UNION IA 52175 (319) 422-3811 320 161317 MARENGO MEMORIAL HOSPITAL 300 WEST MAY STREET PO BOX 228 MARENGO IA 52301 (319) 642-5543 470 161318 VETERANS MEMORIAL 40 1ST ST SE WAUKON IA 52172 (319) 568-3411 20 161319 CENTRAL COMMUNITY HOSPITAL 901 DAVIDSON STREET NW ELKADER IA 52043 (563) 245-7000 210 161320 COMMUNITY MEMORIAL HOSPITAL 909 WEST FIRST STREET SUMNER IA 50674 (563) 578-3275 80 161321 MERRILL PIONEER COMMUNITY HOSPITAL 801 SOUTH GREENE STREET ROCK RAPIDS IA 51246 (712) 472-2591 590 161322 DALLAS COUNTY HOSPITAL 610 TENTH STREET PERRY IA 50220 (515) 465-2922 240 161323 MITCHELL COUNTY REGIONAL HEALTH CENTER 616 NORTH EIGHTH STREET OSAGE IA 50461 (641) 732-6000 650 161324 GRAPE COMMUNITY HOSPITAL PO BOX 246 HWY 275 NORTH HAMBURG IA 51640 (712) 382-1515 350 161325 GREENE COUNTY MEDICAL CENTER 1000 WEST LINCOLNWAY JEFFERSON IA 50129 (515) 386-2114 360 161326 MADISON COUNTY HOSPITAL 300 HUTCHINGS STREET WINTERSET IA 50273 (515) 462-2373 600 161327 DAVIS COUNTY HOSPITAL 507 NORTH MADISON BLOOMFIELD IA 52537 (641) 664-2145 250 161328 REGIONAL HEALTH SERVICES OF IOWA 325 EIGHTH AVENUE WEST CRESCO IA 52136 (319) 547-2101 440 161329 JACKSON COUNTY PUBLIC HOSPITAL 700 WEST GROVE STREET MAQUOKETA IA 52060 (319) 652-2474 480 161330 AUDUBON COUNTY MEMORIAL HOSPITAL 515 PACIFIC STREET AUDUBON IA 50025 (712) 563-2611 40 161331 MERCY MEDICAL CENTER 308 NORTH MAPLE AVENUE NEW HAMPTON IA 50659 (641) 394-4121 180 161332 MANNING REGIONAL HEALTHCARE CE 410 MAIN STREET MANNING IA 51455 (712) 653-2072 130 161333 STORY COUNTY HOSPITAL 630 SIXTH STREET NEVADA IA 50201 (515) 382-2111 840 161334 HUMBOLDT COUNTY MEMORIAL HOSPITAL 1000 NORTH 15TH STREET HUMBOLDT IA 50548 (515) 332-4200 450 161335 PEOPLES MEMORIAL HOSPITAL OF BUCH CO 1600 FIRST STREET EAST INDEPENDENCE IA 50644 (319) 334-6071 90 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 47 Provider ID Hospital Name Address City State ZIP Telephone County 161336 HEGG MEMORIAL CRITICAL ACCESS HOSPITAL 1202 21ST AVENUE ROCK VALLEY IA 51247 (712) 476-8000 830 161337 VAN BUREN COUNTY HOSPITAL 304 FRANKLIN PO BOX 70 KEOSAUQUA IA 52565 (319) 293-3171 880 161338 MERCY HOSPITAL 201 EIGHTH AVENUE SE OELWEIN IA 50662 (319) 283-6000 320 161339 WAVERLY MUNICIPAL HOSPITAL 312 9TH STREET SW WAVERLY IA 50677 (319) 352-4120 80 161340 DECATUR COUNTY HOSPITAL 1405 NW CHURCH STREET LEON IA 50144 (641) 446-4871 260 161341 LUCAS COUNTY HOSPITAL 1200 NORTH SEVENTH STREET CHARITON IA 50049 (641) 774-3000 580 161342 MONROE COUNTY HOSPITAL 6580 165TH STREET ALBIA IA 52531 (641) 932-2134 670 161343 REGIONAL MEDICAL CENTER OF NE IOWA 709 WEST MAIN MANCHESTER IA 52057 (562) 927-3232 270 164002 MENTAL HEALTH INSTITUTE 1200 NORTH CEDAR STREET CHEROKEE IA 51012 (712) 225-2594 170 164003 MENTAL HEALTH INSTITUTE P O BOX 111 INDEPENDENCE IA 50644 (319) 334-2583 90 164004 MENTAL HEALTH INSTITUTE 1200 EAST WASHINGTON STREET MOUNT PLEASANT IA 52641 (319) 385-7231 430 164005 MENTAL HEALTH INSTITUTE 1800 NORTH 16TH STREET CLARINDA IA 51632 (712) 542-2161 720 170001 NEWMAN REGIONAL HEALTH 1201 W 12TH AVE EMPORIA KS 66801 (316) 343-6800 550 170006 MT CARMEL MEDICAL CENTER 1102 E CENTENNIAL PITTSBURG KS 66762 (316) 231-6100 180 170008 CITIZENS MEDICAL CENTER 100 E COLLEGE DR COLBY KS 67701 (785) 462-7511 960 170009 SAINT JOHN HOSPITAL 3500 S 4TH ST LEAVENWORTH KS 66048 (913) 680-6000 510 170010 MERCY HOSPITAL INDEPENDENCE 800 W MYRTLE ST INDEPENDENCE KS 67301 (620) 332-3204 620 170012 SALINA REGIONAL MEDICAL CENTER 400 S SANTA FE SALINA KS 67401 (785) 452-7000 840 170013 HAYS MEDICAL CENTER 2220 CANTERBURY DRIVE HAYS KS 67601 (785) 623-5000 250 170014 RANSOM MEMORIAL HOSPITAL 1301 S MAIN ST OTTAWA KS 66067 (785) 229-8200 290 170015 MITCHELL COUNTY HOSPITAL 400 WEST 8TH STREET BELOIT KS 67420 (913) 738-2266 610 170016 ST FRANCIS HOSPITAL & MEDICAL CENTER 1700 W 7TH ST TOPEKA KS 66606 (913) 295-8000 880 170017 SUSAN B ALLEN MEMORIAL HOSPITAL 720 W CENTRAL ST EL DORADO KS 67042 (316) 321-3300 70 170018 FREDONIA REGIONAL HOSPITAL 1527 MADISON PO BOX 579 FREDONIA KS 66736 (316) 378-2121 984 170019 WILLIAM NEWTON MEMORIAL HOSPITAL 1300 E FIFTH AVE WINFIELD KS 67156 (316) 221-2300 170 170020 HUTCHINSON HOSPITAL CORPORATION 1701 E 23RD ST HUTCHINSON KS 67502 (620) 665-2000 770 170022 ATCHISON HOSPITAL 1301 NORTH SECOND STREET ATCHISON KS 66002 (913) 367-6600 20 170023 ST CATHERINE HOSPITAL 410 E WALNUT ST GARDEN CITY KS 67846 (316) 272-2222 270 170024 REPUBLIC COUNTY HOSPITAL 2420 G ST BELLEVILLE KS 66935 (785) 527-2254 780 170025 ST LUKE HOSPITAL 1014 E MELVIN MARION KS 66861 (620) 382-2177 570 170026 HILLSBORO COMMUNITY MEDICAL CENTER 701 S MAIN ST HILLSBORO KS 67063 (316) 947-3114 570 170027 PRATT REGIONAL MEDICAL CENTER 200 COMMODORE ST PRATT KS 67124 (316) 672-7451 750 170030 RUSSELL REGIONAL HOSPITAL 200 S MAIN RUSSELL KS 67665 (913) 483-3131 830 170033 CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY ST GREAT BEND KS 67530 (316) 792-2511 40 170034 MINNEOLA DISTRICT HOSPITAL 212 MAIN STREET PO BOX 127 MINNEOLA KS 67865 (620) 885-4264 120 170037 MEMORIAL HOSPITAL 1105 SUNSET AVE MANHATTAN KS 66502 (785) 776-3300 800 170039 SUMNER REGIONAL MEDICAL CENTER 1323 NORTH A STREET WELLINGTON KS 67152 (620) 326-7451 950 170040 UNIVERSITY OF KANSAS HOSPITAL 3901 RAINBOW BLVD KANSAS CITY KS 66160 (913) 588-5000 986 170041 OSBORNE COUNTY MEMORIAL HOSPITAL 424 W NEW HAMPSHIRE ST OSBORNE KS 67473 (913) 346-2121 700 170045 COMMUNITY HOSPITAL ONAGA INC 120 W 8TH ST ONAGA KS 66521 (785) 889-4274 740 170049 OLATHE MEDICAL CENTER 20333 W 151ST ST OLATHE KS 66061 (913) 791-4200 450 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 48 Provider ID Hospital Name Address City State ZIP Telephone County 170052 KINGMAN COMMUNITY HOSPITAL 750 WEST AVENUE D KINGMAN KS 67068 (620) 532-3147 470 170054 CLAY COUNTY MEDICAL CENTER 617 LIBERTY ST CLAY CENTER KS 67432 (913) 632-2144 130 170056 LINCOLN COUNTY HOSPITAL 624 N SECOND ST LINCOLN KS 67455 (785) 524-4403 520 170058 MERCY HOSPITAL 821 BURKE ST FORT SCOTT KS 66701 (316) 223-2200 50 170060 DECATUR COUNTY HOSPITAL 810 W COLUMBIA OBERLIN KS 67749 (785) 475-2208 190 170061 PHILLIPS COUNTY HOSPITAL 1150 STATE ST PHILLIPSBURG KS 67661 (913) 543-5226 730 170068 SOUTHWEST MEDICAL CENTER 315 W 15TH ST PO BOX 1340 LIBERAL KS 67901 (316) 624-1651 870 170070 MORRIS COUNTY HOSPITAL 600 N WASHINGTON ST KPOB 275 COUNCIL GROVE KS 66846 (620) 767-6811 630 170074 GEARY COMMUNITY HOSPITAL 1102 ST MARYS RD JUNCTION CITY KS 66441 (913) 238-4131 300 170075 MERCY HOSPITAL 218 E PACK ST PO BOX 180 MOUNDRIDGE KS 67107 (620) 345-6391 560 170076 WASHINGTON COUNTY HOSPITAL 304 E 3RD ST WASHINGTON KS 66968 (913) 325-2211 982 170077 TREGO COUNTY-LEMKE MEMORIAL HOSPITAL 320 N 13TH ST WAKEENEY KS 67672 (913) 743-2182 970 170080 GOVE COUNTY HOSPITAL 5TH & GARFIELD QUINTER KS 67752 (913) 754-3341 310 170082 GREAT PLAINS OF GREELEY CO 506 3RD ST TRIBUNE KS 67879 (620) 376-4221 350 170085 SCOTT COUNTY HOSPITAL 310 EAST THIRD SCOTT CITY KS 67871 (316) 872-5811 841 170086 STORMONT VAIL HEALTHCARE 1500 SW 10TH ST TOPEKA KS 66604 (785) 354-6849 880 170090 HODGEMAN COUNTY HEALTH CENTER 809 W BRAMLEY JETMORE KS 67854 (620) 357-8361 410 170093 SMITH COUNTY MEMORIAL HOSPITAL 614 SOUTH MAIN STREET SMITH CENTER KS 66967 (785) 282-6845 910 170094 COFFEY COUNTY HOSPITAL 801 N 4TH ST PO BOX 189 BURLINGTON KS 66839 (620) 364-2121 150 170095 CLOUD COUNTY HEALTH CENTER 1100 HIGHLAND DR CONCORDIA KS 66901 (785) 243-1234 140 170097 GOODLAND REGIONAL MEDICAL CENTER 220 W SECOND GOODLAND KS 67735 (785) 899-6001 900 170098 HOSPITAL DISTRICT 1 CRAWFORD COUNTY 302 N HOSPITAL DR GIRARD KS 66743 (316) 724-8291 180 170099 HANOVER HOSPITAL 205 S HANOVER HANOVER KS 66945 (785) 337-2214 982 170101 LINDSBORG COMMUNITY HOSPITAL 605 W LINCOLN ST LINDSBORG KS 67456 (785) 227-3308 560 170103 NEWTON MEDICAL CENTER 600 MEDICAL CENTER DR PO BOX 308 NEWTON KS 67114 (316) 283-2700 390 170104 SHAWNEE MISSION MEDICAL CENTER 9100 W 74TH ST SHAWNEE MISSION KS 66201 (913) 676-2184 450 170105 MEMORIAL HOSPITAL 1000 HOSPITAL DR MCPHERSON KS 67460 (316) 241-2250 560 170109 MIAMI COUNTY HOSPITAL 501 S HOSPITAL DR PO BOX 365 PAOLA KS 66071 (913) 294-2327 600 170110 BOB WILSON MEM GRANT CO HOSPITAL 415 N MAIN ST ULYSSES KS 67880 (620) 356-1266 330 170113 COMMUNITY MEMORIAL HEALTHCARE INC 708 N 18TH ST MARYSVILLE KS 66508 (785) 562-2311 580 170114 MEMORIAL HOSPITAL 511 NE TENTH ST ABILENE KS 67410 (913) 263-2100 200 170116 ALLEN COUNTY HOSPITAL 101 S 1ST ST IOLA KS 66749 (316) 365-3131 0 170120 LABETTE COUNTY MEDICAL CENTER SOUTH HWY 59 PO BOX 956 PARSONS KS 67357 (316) 421-4880 490 170122 VIA CHRISTI REGIONAL MEDICAL CENTER 929 N ST FRANCIS ST WICHITA KS 67214 (316) 268-5000 860 170123 WESLEY MEDICAL CENTER,LLC 550 N HILLSIDE ST WICHITA KS 67214 (316) 688-2000 860 170133 CUSHING MEMORIAL HOSPITAL 711 MARSHALL ST LEAVENWORTH KS 66048 (913) 684-1100 510 170137 LAWRENCE MEMORIAL HOSPITAL 325 MAINE ST LAWRENCE KS 66044 (913) 749-6100 220 170142 MERCY HEALTH CENTER OF MANHATTAN INC 1823 COLLEGE AVE MANHATTAN KS 66502 (913) 776-3322 800 170143 NEOSHO MEMORIAL HOSPITAL 629 S PLUMMER CHANUTE KS 66720 (316) 431-4000 660 170144 HERTLER REGIONAL MEDICAL CENTER 328 POPLAR ST HALSTEAD KS 67056 (316) 835-4100 390 170145 COFFEYVILLE REGIONAL MEDICAL CENTER 1400 W 4TH ST COFFEYVILLE KS 67337 (316) 251-1200 620 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 49 Provider ID Hospital Name Address City State ZIP Telephone County 170146 PROVIDENCE MEDICAL CENTER 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 (913) 596-4000 986 170147 VIA CHRISTI RIVERSIDE MEDICAL CENTER 2622 WEST CENTRAL AVENUE WICHITA KS 67203 (316) 946-5000 860 170150 SOUTH CENTRAL KS REGIONAL MED CENTER 216 W BIRCH ST ARKANSAS CITY KS 67005 (316) 442-2500 170 170151 HARPER HOSPITAL DISTRICT 5 12TH & MAPLE HARPER KS 67058 (316) 896-7324 380 170166 MORTON COUNTY HOSPITAL 445 N HILLTOP ELKHART KS 67950 (620) 697-2141 640 170171 AUGUSTA MEDICAL COMPLEX INC 2101 DEARBORN AUGUSTA KS 67010 (316) 775-5421 70 170175 WESTERN PLAINS MEDICAL COMPLEX 3001 AVENUE A DODGE CITY KS 67801 (316) 225-8400 280 170176 OVERLAND PARK REGIONAL MEDICAL CENTER 10500 QUIVIRA RD OVERLAND PARK KS 66215 (913) 541-5000 450 170180 MEADOWBROOK REHABILITATION HOSPITAL 427 WEST MAIN STREET GARDNER KS 66030 (913) 856-8747 450 170182 MENORAH MEDICAL CENTER 5721 W 119TH ST OVERLAND PARK KS 66209 (913) 498-6000 450 170183 KANSAS SURGERY & RECOVERY CENTER LP 2770 N WEBB ROAD WICHITA KS 67226 (316) 634-0090 860 170185 SAINT LUKES SOUTH HOSPSITAL 12300 METCALF OVERLAND PARK KS 66213 (913) 317-7000 450 170186 KANSAS HEART HOSPITAL 3601 N WEBB ROAD WICHITA KS 67226 (316) 630-5000 860 170187 SALINA SURGICAL HOSPITAL LLC 401 SOUTH SANTA FE SALINA KS 67401 (785) 827-0610 840 170188 KANSAS CITY ORTHOPEDIC INSTITUTE 3651 COLLEGE BLVD LEAWOOD KS 66211 (913) 338-4100 450 170190 MANHATTAN SURGICAL HOSPITAL LLC 1829 COLLEGE AVENUE MANHATTAN KS 66502 (785) 776-5100 800 170191 SURGICAL AND DIAGNOSTIC CTR OF GR BEND 514 CLEVELAND STREET GREAT BEND KS 67530 (620) 792-1448 40 170192 GALICHIA HEART HOSPITAL LLC 2610 N WOODLAWN WICHITA KS 67220 (316) 219-9101 860 170193 EMPORIA SURGICAL HOSPITAL 1602 WEST 15TH STREET EMPORIA KS 66801 (620) 342-8822 550 170194 DOCTORS SPECIALTY HOSPITAL LLC 4901 COLLEGE LEAWOOD KS 66211 (913) 529-1801 450 171300 GRISELL MEMORIAL HOSPITAL DISTRICT 1 210 SOUTH VERMONT PO BOX 268 RANSOM KS 67572 (785) 731-2231 670 171301 ELLINWOOD DISTRICT HOSPITAL 605 N MAIN STREET ELLINWOOD KS 67526 (316) 564-2548 40 171302 OSWEGO HEALTH CENTER 800 BARKER DRIVE OSWEGO KS 67356 (620) 795-2921 490 171303 LANE COUNTY HOSPITAL 243 S SECOND PO BOX 969 DIGHTON KS 67839 (620) 397-5321 500 171304 ASHLAND DISTRICT HOSPSITAL 709 OAK STREET PO BOX 188 ASHLAND KS 67831 (620) 635-2241 120 171305 CEDAR VALE COMMUNITY HOSPITAL 501 CEDAR ST CEDAR VALE KS 67024 (316) 758-2266 90 171306 WICHITA COUNTY HEALTH CENTER 211 E EARL STREET LEOTI KS 67861 (620) 375-2233 983 171307 RAWLINS COUNTY HOSPITAL 707 GRANT ST PO BOX 47 ATWOOD KS 67730 (785) 626-3211 760 171308 ST JOHNS MAUDE NORTON MEMORIAL HOSP 220 N PENNSYLVANIA COLUMBUS KS 66725 (620) 429-2545 100 171309 JEWELL COUNTY HOSPITAL 100 CRESTVUE AVE PO BOX 327 MANKATO KS 66956 (785) 378-3137 440 171310 CHEYENNE COUNTY HOSPITAL 210 W FIRST STREET PO BOX 547 SAINT FRANCIS KS 67756 (785) 332-2104 110 171311 PLAINVILLE RURAL HOSPITAL DIST #1 304 S COLORADO PLAINVILLE KS 67663 (785) 434-4553 810 171312 COMANCHE COUNTY HOSPITAL 2ND & FRISCO STREET COLDWATER KS 67029 (620) 582-2144 160 171313 KEARNY COUNTY HOSPITAL 500 THORPE STREET PO BOX 744 LAKIN KS 67860 (620) 355-7111 451 171314 JEFFERSON COUNTY MEMORIAL HOSPITAL 408 DELAWARE ST WINCHESTER KS 66097 (913) 774-4340 430 171315 NEMAHA VALLEY COMMUNITY HOSPITAL 1600 COMMUNITY DR SENECA KS 66538 (785) 336-6181 650 171316 ANDERSON COUNTY HOSPITAL 421 S MAPLE PO BOX 309 GARNETT KS 66032 (785) 448-3131 10 171317 EDWARDS CO HOSPITAL & HEALTHCARE CTR 620 W EIGHTH STREET KINSLEY KS 67547 (620) 659-3621 230 171318 SEDAN CITY HOSPITAL 300 NORTH ST PO BOX C SEDAN KS 67361 (620) 725-3115 90 171319 HOLTON COMMUNITY HOSPITAL 510 KANSAS AVE HOLTON KS 66436 (785) 364-2116 420 171320 NORTHEAST KS CRT FOR HEALTH & WELLNESS 240 W 18TH STREET HORTON KS 66439 (913) 486-2642 60 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 50 Provider ID Hospital Name Address City State ZIP Telephone County 171321 MEADE DISTRICT HOSPITAL 510 E CARTHAGE PO BOX 680 MEADE KS 67864 (620) 873-2141 590 171322 HAMILTON COUNTY HOSPITAL AVENUE G & HUSER PO BOX 948 SYRACUSE KS 67878 (620) 384-7461 370 171323 STAFFORD DISTRICT HOSPITAL #4 602 S BUCKEYE STAFFORD KS 67578 (620) 234-5221 920 171324 SATANTA DISTRICT HOSPITAL CHEYENNE & APACHE SATANTA KS 67870 (620) 649-2761 391 171325 GRAHAM COUNTY HOSPITAL 304 WEST PROUT STREET HILL CITY KS 67642 (785) 421-2121 320 171326 LOGAN COUNTY HOSPITAL 211 CHERRY AVENUE OAKLEY KS 67748 (785) 672-3211 540 171327 ELLSWORTH COUNTY MEDICAL CENTER 1604 AYLWARD STREET ELLSWORTH KS 67439 (785) 472-3111 260 171328 OTTAWA COUNTY HOSPITAL 215 E 8TH STREET PO BOX 290 MINNEAPOLIS KS 67467 (785) 392-2122 710 171329 SUMNER COUNTY HOSPITAL DISTRICT #1 601 SOUTH OSAGE STREET CALDWELL KS 67022 (620) 845-6492 950 171330 HOSPITAL DISTRICT #1 OF RICE COUNTY 619 S CLARK AVENUE LYONS KS 67554 (620) 257-5173 790 171331 KIOWA DISTRICT HOSPITAL 810 DRUMM STREET KIOWA KS 67070 (620) 825-4131 30 171332 GREAT PLAINS OF KIOWA COUNTY 501 S WALNUT STREET GREENSBURG KS 67054 (620) 723-3441 480 171333 CLARA BARTON HOSPITAL 250 W 9TH STREET HOISINGTON KS 67544 (620) 653-2114 40 171334 MEDICINE LODGE MEMORIAL HOSPITAL 710 N WALNUT STREET MEDICINE LODGE KS 67104 (620) 886-3771 30 171335 STEVENS COUNTY HOSPITAL 1006 S JACKSON PO BOX 10 HUGOTON KS 67951 (620) 544-8511 940 171336 NESS COUNTY HOSPITAL DISTRICT #2 312 E CUSTER STREET NESS CITY KS 67560 (785) 798-2291 670 171337 WAMEGO CITY HOSPITAL 711 GENN DRIVE WAMEGO KS 66547 (785) 456-2295 740 171338 SABETHA COMMUNITY HOSPITAL 14TH AND OREGON PO BOX 229 SABETHA KS 66534 (785) 284-2121 650 171339 GREENWOOD COUNTY HOSPITAL 100 W 16TH STREET EUREKA KS 67045 (620) 583-7451 360 171340 HERINGTON MUNICIPAL HOSPITAL 100 E HELEN STREET HERINGTON KS 67449 (785) 258-2207 200 171341 HIAWATHA COMMUNITY HOSPITAL 300 UTAH STREET HIAWATHA KS 66434 (785) 742-2131 60 171342 RUSH COUNTY MEMORIAL HOSPITAL 801 LOCUST BOX 520 LA CROSSE KS 67548 (785) 222-2545 820 171343 STANTON COUNTY HOSPITAL 404 N CHESTNUR PO BOX 779 JOHNSON KS 67855 (620) 492-6250 921 171344 WILSON COUNTY HOSPITAL 205 MILL PO BOX 360 NEODESHA KS 66757 (620) 325-2611 984 171345 ST JOSPEH MEMORIAL HOSPITAL 923 CARROLL LARNED KS 67550 (620) 285-3161 720 171346 HOSPITAL DISTRICT #6 OF HARPER COUNTY 1101 E SPRING STREET ANTHONY KS 67003 (620) 842-5111 380 171347 SHERIDAN COUNTY HOSPITAL 826 18TH STRET PO BOX 167 HOXIE KS 67740 (785) 675-3281 890 171348 NORTON COUNTY HOSPITAL 102 E HOLME STREET NORTON KS 67654 (785) 877-3351 680 172003 WICHITA SPECIALTY HOSPITAL 8080 E PAWNEE WICHITA KS 67207 (316) 682-0004 860 172004 SPECIALTY HOSPITAL OF MID-AMERICA 6509 W 103RD ST OVERLAND PARK KS 66212 (913) 649-3701 450 172005 SELECT SPECIALTY HOSPITAL OF KS CITY 10500 QUIVIRA ROAD 4TH FLOOR OVERLAND PARK KS 66215 (913) 541-5886 986 172006 SELECT SPECIALTY HOSPITAL OF TOPEKA 1700 W 7TH ST SUITE 840 TOPEKA KS 66606 (913) 295-5551 880 172007 SELECT SPECIALTY HOSPITAL WICHITA 550 NORTH HILLSIDE 4 WEST WICHITA KS 67214 (316) 688-3900 860 173025 KANSAS REHABILITATION HOSPITAL 1504 SW 8TH AVE TOPEKA KS 66606 (785) 235-6600 880 173026 MID AMERICA REHABILITATION HOSPITAL 5701 W 110TH ST OVERLAND PARK KS 66211 (913) 491-2400 450 173027 WESLEY REHABILITATION HOSPITAL 8338 W 13TH ST WICHITA KS 67212 (316) 729-9999 860 173028 VIA CHRISTI REHABILITATION CENTER INC 1151 N ROCK RD WICHITA KS 67206 (316) 634-3400 860 173300 CHILDRENS MERCY HOSPITAL SOUTH 5808 W 110TH STREET OVERLAND PARK KS 66212 (913) 001-0000 450 174004 OSAWATOMIE STATE HOSP PSYCHIATRIC P O BOX 500 OSAWATOMIE KS 66064 (913) 755-3151 600 174006 LARNED STATE HOSPITAL ROUTE #3 BOX 89 LARNED KS 67550 (316) 285-2131 720 174010 RAINBOW MENTAL HLTH FACILITY POX 3208 KANSAS CITY KS 66103 (913) 384-1880 986 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 51 Provider ID Hospital Name Address City State ZIP Telephone County 174016 PRAIRIE VIEW INC 1901 E FIRST STREET PO BOX 467 NEWTON KS 67114 (316) 662-4700 390 180001 ST LUKE HOSP EAST 85 N GRAND AV FORT THOMAS KY 41075 (859) 572-3100 180 180002 WHITESBURG ARH HOSPITAL 240 HOSPITAL RD WHITESBURG KY 41858 (606) 633-3500 660 180004 MUHLENBERG COMMUNITY HOSPITAL 440 HOPKINSVILLE ST BOX 387 GREENVILLE KY 42345 (270) 338-8000 880 180005 HIGHLANDS REGIONAL MEDICAL CENTER US 23 N BOX 668 PRESTONSBURG KY 41653 (606) 886-8511 350 180006 JENKINS COMMUNITY HOSP MAIN ST JENKINS KY 41537 (606) 832-2171 660 180007 SAMARITAN HOSPITAL 310 S LIMESTONE ST LEXINGTON KY 40508 (859) 226-7000 330 180009 KINGS DAUGHTERS MEDICAL CENTER 2201 LEXINGTON AV ASHLAND KY 41101 (606) 327-4401 90 180010 ST JOSEPH HOSP ONE ST JOSEPH DR LEXINGTON KY 40504 (859) 278-3436 330 180011 MARYMOUNT MEDICAL CENTER 310 EAST NINTH ST LONDON KY 40741 (606) 878-6520 620 180012 HARDIN MEMORIAL HOSP 913 NORTH DIXIE AVE ELIZABETHTOWN KY 42701 (270) 706-1212 460 180013 MEDICAL CENTER,THE 250 PARK ST BOX 90010 BOWLING GREEN KY 42102 (270) 622-2800 986 180016 JEWISH HOSPITAL SHELBYVILLE 727 HOSPITAL DR SHELBYVILLE KY 40065 (502) 647-4000 978 180017 T J SAMSON COMMUNITY HOSP 1301 N RACE ST GLASGOW KY 42141 (270) 651-4159 40 180018 ST CLAIRE MEDICAL CENTER 222 MEDICAL CIRCLE MOREHEAD KY 40351 (606) 783-6500 975 180019 MEADOWVIEW REGIONAL MEDICAL CTR 989 MEDICAL PARK DR MAYSVILLE KY 41056 (606) 759-5311 800 180020 MIDDLESBORO ARH HOSPITAL 3600 W CUMBERLAND AV MIDDLESBORO KY 40965 (606) 242-1101 60 180021 PINEVILLE COMMUNITY HOSP 850 RIVERVIEW AVE PINEVILLE KY 40977 (606) 337-3051 60 180024 NORTON SPRING VIEW HOSPITAL 320 LORETTO RD LEBANON KY 40033 (270) 692-3161 770 180025 FLAGET MEMORIAL HOSPITAL 201 CATHEDRAL MANOR BARDSTOWN KY 40004 (502) 348-3923 890 180026 MARSHALL CO HOSP 503 GEORGE MCCLAIN DR BENTON KY 42025 (270) 527-4800 780 180027 MURRAY-CALLOWAY CO HOSP 803 POPLAR ST MURRAY KY 42071 (270) 762-1100 270 180028 MCDOWELL ARH HOSPITAL PO BOX 247 RT 122 MC DOWELL KY 41647 (606) 377-3400 350 180029 HAZARD ARH REGIONAL MEDICAL CENTER 100 MEDICAL CENTER DRIVE HAZARD KY 41701 (606) 439-1331 960 180035 ST ELIZABETH MEDICAL CENTER 401 EAST 20TH STREET COVINGTON KY 41014 (859) 292-2000 580 180036 OUR LADY OF BELLEFONTE HOSPITAL ST CHRISTOPHER DR ASHLAND KY 41101 (606) 833-3333 440 180037 CARITAS MEDICAL CENTER 1850 BLUEGRASS AV LOUISVILLE KY 40215 (502) 361-6000 550 180038 OWENSBORO MERCY HEALTH SYSTEM 811 E PARRISH AVE P O BOX 20007 OWENSBORO KY 42303 (502) 688-2000 290 180040 JEWISH HOSP FRAZIER REHAB 217 E CHESTNUT ST LOUISVILLE KY 40202 (502) 587-4413 550 180041 OHIO CO HOSP 1211 MAIN ST HARTFORD KY 42347 (270) 298-7411 910 180043 MEMORIAL HOSP INC 401 MEMORIAL DR MANCHESTER KY 40962 (606) 598-5104 250 180044 PIKEVILLE METHODIST HOSPITAL 911 S BYPASS PIKEVILLE KY 41501 (606) 437-3500 970 180045 ST LUKE HOSP WEST 7380 TURFWAY RD FLORENCE KY 41042 (859) 962-5200 70 180046 BOURBON COMMUNITY HOSPITAL 9 LINVILLE DR PARIS KY 40361 (859) 987-1000 80 180047 JANE TODD CRAWFORD MEMORIAL HOSP 202 MILBY ST GREENSBURG KY 42743 (270) 932-4211 421 180048 EPHRAIM MCDOWELL REGIONAL MED CENTER 217 S THIRD ST DANVILLE KY 40422 (859) 236-4121 100 180049 PATTIE A CLAY HOSP EASTERN BYPASS RICHMOND KY 40475 (859) 623-3131 750 180050 HARLAN ARH HOSPITAL 81 BALL PARK RD HARLAN KY 40831 (606) 573-8100 470 180051 JENNIE STUART MEDICAL CENTER INC 320 WEST 18TH STREET HOPKINSVILLE KY 42240 (270) 887-0100 230 180053 FLEMING COUNTY HOSPITAL 920 ELIZAVILLE RD FLEMINGSBURG KY 41041 (606) 849-2351 340 180054 CALDWELL CO HOSP 101 HOSPITAL DRIVE BOX 410 PRINCETON KY 42445 (270) 365-0300 160 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 52 Provider ID Hospital Name Address City State ZIP Telephone County 180055 BEREA HOSP 305 ESTILL ST BEREA KY 40403 (859) 986-3151 750 180056 METHODIST HOSPITAL 1305 N ELM ST HENDERSON KY 42420 (270) 827-7700 500 180063 KNOX CO HOSP ONE HOSPITAL DRIVE PO BOX 160 BARBOURVILLE KY 40906 (606) 546-4175 600 180064 MARY CHILES HOSP 50 STERLING AV MOUNT STERLING KY 40353 (859) 498-1220 860 180066 LOGAN MEMORIAL HOSPITAL 1625 S NASHVILLE RD RUSSELLVILLE KY 42276 (270) 726-4011 700 180067 UNIVERSITY OF KENTUCKY HOSP 800 ROSE ST LEXINGTON KY 40536 (859) 323-5767 330 180069 WILLIAMSON ARH HOSPITAL 2000 CENTRAL AV SOUTH WILLIAMSON KY 41503 (606) 237-1700 970 180070 TWINS LAKES REGIONAL MEDICAL CENTER 910 WALLACE AV LEITCHFIELD KY 42754 (270) 259-9400 420 180078 PAUL B HALL REGIONAL MEDICAL CENTER 625 W JAMES S TRIMBLE BLVD BOX 1487 PAINTSVILLE KY 41240 (606) 789-3511 570 180079 HARRISON MEMORIAL HOSP 1210 KY HIGHWAY 36E CYNTHIANA KY 41031 (859) 234-2300 480 180080 BAPTIST REGIONAL MEDICAL CENTER 1 TRILLIUM WAY CORBIN KY 40701 (606) 528-1212 990 180087 TAYLOR CO HOSP 1700 OLD LEBANON RD CAMPBELLSVILLE KY 42718 (270) 465-3561 981 180088 NORTON HOSP/KOSAIR CHILDREN'S HOSP/NOR 200 E CHESTNUT ST LOUISVILLE KY 40202 (502) 629-8000 550 180092 CLARK REGIONAL MEDICAL CENTER 1107 W LEXINGTON AV WINCHESTER KY 40391 (859) 745-3500 240 180093 REGIONAL MEDICAL CTR OF HOPKINS CO 900 HOSPITAL DR MADISONVILLE KY 42431 (270) 825-5100 530 180094 BRECKINRIDGE MEMORIAL HOSP 1011 OLD HIGHWAY 60 HARDINSBURG KY 40143 (270) 756-7000 130 180095 CRITTENDEN CO HOSP HIGHWAY 60 S BOX 386 MARION KY 42064 (270) 965-5281 270 180099 FORT LOGAN HOSP 124 PORTMAN AV STANFORD KY 40484 (606) 365-2187 680 180101 GEORGETOWN COMMUNITY HOSPITAL 1140 LEXINGTON RD GEORGETOWN KY 40324 (502) 868-1100 977 180102 LOURDES HOSP 1530 LONE OAK RD PADUCAH KY 42001 (270) 444-2444 720 180103 CENTRAL BAPTIST HOSP 1740 NICHOLASVILLE RD LEXINGTON KY 40503 (859) 275-6100 330 180104 WESTERN BAPTIST HOSP 2501 KENTUCKY AV PADUCAH KY 42001 (270) 575-2100 20 180105 MONROE CO MEDICAL CENTER 529 CAPP HARLAN RD TOMPKINSVILLE KY 42167 (270) 487-9231 850 180106 CLINTON CO HOSP INC 723 BURKESVILLE RD ALBANY KY 42602 (606) 387-6421 260 180108 CUMBERLAND CO HOSP 299 GLASGOW RD BURKESVILLE KY 42717 (270) 864-2511 271 180115 ROCKCASTLE HOSP 145 NEWCOMB AVE P O BOX 1310 MOUNT VERNON KY 40456 (606) 256-2195 974 180116 JACKSON PURCHASE MEDICAL CENTER 1099 MEDICAL CENTER CIRCLE MAYFIELD KY 42066 (270) 251-4500 410 180117 PARKWAY REGIONAL HOSP 2000 HOLIDAY LANE FULTON KY 42041 (270) 472-2522 361 180120 MEDICAL CENTER AT FRANKLIN,THE 1100 BROOKHAVEN RD FRANKLIN KY 42135 (270) 586-3253 979 180121 LIVINGSTON HOSP AND HEALTHCARE SER INC 131 HOSPITAL DR SALEM KY 42078 (270) 988-2299 690 180124 GREENVIEW REGIONAL HOSP 1801 ASHLEY CIRCLE BOWLING GREEN KY 42101 (270) 793-1000 986 180126 WAYNE CO HOSP INC 166 HOSPITAL ST MONTICELLO KY 42633 (606) 348-9343 988 180127 FRANKFORT REGIONAL MEDICAL CENTER 299 KINGS DAUGHTERS DRIVE FRANKFORT KY 40601 (502) 875-5240 360 180128 THREE RIVERS MEDICAL CENTER HIGHWAY 644 PO BOX 769 LOUISA KY 41230 (606) 638-9451 630 180129 MARY BRECKINRIDGE HOSPITAL HOSPITAL DRIVE HYDEN KY 41749 (606) 672-2901 650 180130 BAPTIST HOSP EAST 4000 KRESGE WAY LOUISVILLE KY 40207 (502) 897-8100 550 180132 LAKE CUMBERLAND REGIONAL HOSPITAL 305 LANGDON ST P O BOX 620 SOMERSET KY 42501 (606) 679-7441 972 180134 RUSSELL CO HOSP DOWELL RD BOX 1610 RUSSELL SPRINGS KY 42642 (270) 866-4141 976 180138 BAPTIST HOSPITAL NORTHEAST 1025 NEW MOODY LANE LA GRANGE KY 40031 (502) 222-5388 920 180139 KENTUCKY RIVER MEDICAL CENTER 540 JETT DR JACKSON KY 41339 (606) 666-6000 120 180141 UNIVERSITY OF LOUISVILLE HOSPITAL 530 S JACKSON ST LOUISVILLE KY 40202 (502) 562-4002 550 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 53 Provider ID Hospital Name Address City State ZIP Telephone County 180143 ST JOSEPH EAST 150 NORTH EAGLE CREEK DR LEXINGTON KY 40509 (859) 268-4800 330 181300 GARRARD COUNTY MEMORIAL HOSPITAL 308 WEST MAPLE AVENUE LANCASTER KY 40444 (859) 792-6844 390 181301 MARCUM AND WALLACE MEMORIAL HOSPITAL 60 MERCY COURT IRVINE KY 40336 (606) 723-2115 320 181302 JAMES B HAGGIN MEMORIAL HOSPITAL 464 LINDEN AVENUE HARRODSBURG KY 40330 (859) 734-5441 830 181303 NICHOLAS COUNTY HOSPITAL 2323 CONCRETE ROAD CARLISLE KY 40311 (859) 289-7181 900 181304 TRIGG COUNTY HOSPITAL 254 MAIN STREET CADIZ KY 42211 (270) 522-3215 983 181305 OUR LADY OF THE WAY 11203 MAIN STREET MARTIN KY 41649 (606) 285-5181 350 181306 METHODIST HOSPITAL UNION COUNTY 4604 US HIGHWAY 60 WEST MORGANFIELD KY 42437 (270) 389-3030 985 181307 MORGAN COUNTY ARH CRITICAL ACCESS HOSP 476 LIBERTY ROAD WEST LIBERTY KY 41472 (606) 743-3186 861 181308 BLUEGRASS COMMUNITY HOSPITAL 360 AMSDEN AVENUE VERSAILLES KY 40383 (859) 873-3111 992 181309 CASEY COUNTY HOSPITAL 187 WOLFORD AVENUE LIBERTY KY 42539 (606) 787-6275 220 181310 CARROLL COUNTY HOSPITAL 309 11TH STREET CARROLLTON KY 41008 (502) 732-4321 191 181311 ST ELIZABETH MEDICAL CENTER GRANT CTY 238 BARNES ROAD WILLIAMSTOWN KY 41097 (859) 824-8240 400 181312 NEW HORIZONS HEALTH SYSTEMS INC 30 ROLAND AVE OWENTON KY 40359 (502) 484-2771 930 181313 WESTLAKE REGIONAL HOSPITAL 901 WESTLAKE DRIVE COLUMBIA KY 42728 (270) 384-4753 0 181314 CAVERNA MEMORIAL HOSPITAL 1501 SOUTH DIXIE STREET HORSE CAVE KY 42749 (270) 786-2191 490 182001 KINDRED HOSPITAL LOUISVILLE 1313 ST ANTHONY STREET LOUISVILLE KY 40204 (502) 587-7001 550 182002 CONTINUING CARE HOSP AT ST JOSEPH EAST 150 N EAGLE CREEK DR 4TH FLOOR LEXINGTON KY 40515 (859) 268-4800 330 183026 CARDINAL HILL REHABILITATION HOSP 2050 VERSAILLES RD LEXINGTON KY 40504 (859) 254-5701 330 183027 HEALTH SOUTH NORTHERN 201 MEDICAL VILLAGE DR EDGEWOOD KY 41017 (859) 341-2044 580 183028 HEALTHSOUTH REHAB HOSP OF CENTRAL KY 134 HEARTLAND DR ELIZABETHTOWN KY 42701 (270) 769-3100 460 183029 MEDIPLEX REHAB BOWLING GREEN 1300 CAMPBELL LANE BOWLING GREEN KY 42104 (270) 782-6900 986 183030 GATEWAY REHABILITATION HOSPITAL 5940 MERCHANTS STREET FLORENCE KY 41042 (859) 426-2400 70 183031 GATEWAY REHABILITATION HOSPITAL 315 EAST BROADWAY LOUISVILLE KY 40202 (502) 315-8300 550 184002 WESTERN STATE HOSP RUSSELLVILLE ROAD PO BOX 2200 HOPKINSVILLE KY 42240 (270) 886-4431 230 184004 EASTERN STATE HOSP 627 W 4TH ST LEXINGTON KY 40508 (859) 246-7000 330 184006 NORTHKEY COMMUNITY CARE INTENSIVE SERV 502 FARRELL DRIVE PO BOX 2680 COVINGTON KY 41012 (859) 331-1900 580 184007 TEN BROECK DUPONT INC 1405 BROWNS LANE LOUISVILLE KY 40207 (502) 896-0495 550 184008 TEN BROECK HOSP 8521 LAGRANGE RD LOUISVILLE KY 40242 (502) 426-6380 550 184009 RIDGE BEHAVIORAL HEALTH SYSTEM 3050 RIO DOSA DR LEXINGTON KY 40509 (859) 269-2325 330 184012 LINCOLN TRAIL BEHAVIORAL HEALTH SYSTEM 3909 S WILSON RD P O BOX 369 RADCLIFF KY 40160 (270) 351-9444 460 184013 RIVER VALLEY BEHAVIORAL HEALTH 1000 INDUSTRIAL DRIVE OWENSBORO KY 42301 (270) 689-6800 290 184014 FHC CUMBERLAND HALL 210 WEST 17TH STREET HOPKINSVILLE KY 42240 (270) 886-1919 230 184015 CENTRAL STATE HOSP 10510 LAGRANGE RD LOUISVILLE KY 40223 (502) 253-7060 550 184017 RIVENDELL BEHAVIORAL HEALTH SERVICES 1035 PORTER PIKE BOWLING GREEN KY 42103 (270) 843-1199 986 190001 WASHINGTON ST TAMMANY REG MED CENTER 400 MEMPHIS STREET BOGALUSA LA 70427 (985) 735-1322 580 190002 LAFAYETTE GENERAL MEDICAL CENTER 1214 COOLIDGE AVENUE LAFAYETTE LA 70505 (337) 233-7811 270 190003 DAUTERINE HOSPITAL 600 NORTH LEWIS STREET NEW IBERIA LA 70563 (337) 374-4101 220 190004 THIBODAUX REGIONAL MEDICAL CENTER 602 NORTH ACADIA ROAD THIBODAUX LA 70301 (985) 447-5500 280 190005 MEDICAL CENTER OF LOUISIANA AT N O 1532 TULANE AVE NEW ORLEANS LA 70140 (504) 903-3332 350 190006 UNIVERSITY MEDICAL CENTER 2390 WEST CONGRESS LAFAYETTE LA 70502 (337) 261-6000 270 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 54 Provider ID Hospital Name Address City State ZIP Telephone County 190007 NATCHITOCHES PARISH HOSPITAL 501 KEYSER AVE NATCHITOCHES LA 71457 (318) 352-1200 340 190008 TERREBONNE GENERAL HOSPITAL 8166 MAIN STREET HOUMA LA 70360 (985) 876-2010 540 190009 HUEY P LONG MEDICAL CENTER 352 HOSPITAL BLVD PINEVILLE LA 71360 (318) 448-0811 390 190010 LALLIE KEMP REGIONAL MEDICAL CENTER 52579 HIGHWAY 51 SOUTH INDEPENDENCE LA 70443 (504) 878-9421 520 190011 E A CONWAY MEDICAL CENTER 4864 JACKSON STREET MONROE LA 71210 (318) 388-7000 360 190013 W CALCASIEU CAMERON HOSPITAL 701 EAST CYPRESS STREET SULPHUR LA 70663 (337) 527-4240 90 190014 TECHE REGIONAL MEDICAL CENTER 1125 MARGUERITE STREET MORGAN CITY LA 70381 (504) 384-2200 500 190015 NORTH OAKS MEDICAL CENTER 15790 PAUL VEGA MD DRIVE HAMMOND LA 70403 (985) 345-2700 520 190017 OPELOUSAS GENERAL HOSPITAL 539 EAST PRUDHOMME STREET OPELOUSAS LA 70570 (337) 948-3011 480 190018 FRANKLIN FOUNDATION HOSPITAL 1501 HOSPITAL AVENUE FRANKLIN LA 70538 (337) 828-0760 500 190019 CHRISTUS ST FRANCIS CABRINI HOSPITAL 3330 MASONIC DRIVE ALEXANDRIA LA 71301 (318) 487-1122 390 190020 LANE MEMORIAL HOSPITAL 6300 MAIN STREET ZACHARY LA 70791 (225) 658-4303 160 190025 SAVOY MEDICAL CENTER 801 POINCIANA AVENUE MAMOU LA 70554 (337) 468-5261 190 190026 RAPIDES REGIONAL MEDICAL CENTER 211 4TH STREET ALEXANDRIA LA 71301 (318) 473-3150 390 190027 CHRISTUS ST PATRICK HOSPITAL 524 SOUTH RYAN STREET LAKE CHARLES LA 70601 (337) 436-2511 90 190034 ABBEVILLE GENERAL HOSPITAL 118 N HOSPITAL DR ABBEVILLE LA 70511 (337) 893-5466 560 190036 OCHSNER FOUNDATION HOSPITAL 1516 JEFFERSON HWY NEW ORLEANS LA 70121 (504) 838-3000 250 190037 SOUTH CAMERON MEMORIAL HOSPITAL 5360 WEST CREOLE HIGHWAY CAMERON LA 70631 (337) 542-4111 110 190039 WEST JEFFERSON MEDICAL CENTER 1101 MEDICAL CENTER BLVD MARRERO LA 70072 (504) 347-5511 250 190040 SLIDELL MEMORIAL HOSPITAL 1001 GAUSE BLVD SLIDELL LA 70458 (985) 643-2200 510 190041 CHRISTUS SCHUMPERT HEALTH SYSTEM ONE ST MARY PLACE SHREVEPORT LA 71101 (318) 227-4200 80 190043 ABRAM KAPLAN MEMORIAL HOSPITAL 1310 W 7TH STREET KAPLAN LA 70548 (337) 643-8300 560 190044 AMERICAN LEGION HOSPITAL 1305 CROWLEY RAYNE HIGHWAY CROWLEY LA 70526 (337) 783-3222 0 190045 ST TAMMANY PARISH HOSPITAL 1202 S TYLER COVINGTON LA 70433 (985) 898-4000 510 190046 TOURO INFIRMARY 1401 FOUCHER STREET NEW ORLEANS LA 70115 (504) 897-8246 350 190048 LADY OF THE SEA GENERAL HOSPITAL 200 WEST 134TH PLACE CUT OFF LA 70345 (985) 632-6401 280 190049 RIVERSIDE MEDICAL CENTER 1900 SOUTH MAIN STREET FRANKLINTON LA 70438 (985) 839-4431 580 190050 BEAUREGARD MEMORIAL HOSPITAL 600 S PINE STREET DERIDDER LA 70634 (337) 462-7100 50 190053 JENNINGS AMERICAN LEGION HOSPITAL 1634 ELTON ROAD JENNINGS LA 70546 (337) 824-2490 260 190054 IBERIA GENERAL HOSPITAL & MEDICAL CTR 2315 E MAIN STREET NEW IBERIA LA 70562 (337) 364-0441 220 190059 POINTE COUPEE GENERAL HOSPITAL 2202 FALSE RIVER ROAD NEW ROADS LA 70760 (225) 638-6331 380 190060 LAKE CHARLES MEMORIAL HOSPITAL 1701 OAK PARK BLVD LAKE CHARLES LA 70601 (337) 494-3000 90 190064 OUR LADY OF THE LAKE REG MED CENTER 5000 HENNESSY BLVD BATON ROUGE LA 70808 (225) 765-6565 160 190065 BATON ROUGE GENERAL MEDICAL CENTER 3600 FLORIDA STREET BATON ROUGE LA 70806 (225) 387-7767 160 190077 TRI WARD GENERAL HOSPITAL 409 1ST STREET BERNICE LA 71222 (318) 285-9066 550 190078 EUNICE COMMUNITY MEDICAL CENTER 400 MOOSA BLVD EUNICE LA 70535 (337) 457-5244 480 190079 ST CHARLES HOSPITAL P O BOX 87 LULING LA 70070 (985) 785-6242 440 190081 WEST CARROLL MEMORIAL HOSPITAL 522 ROSS STREET OAK GROVE LA 71263 (318) 428-3237 610 190083 JACKSON PARISH HOSPITAL 165 BEECH SPRING ROAD JONESBORO LA 71251 (318) 259-4435 240 190086 LINCOLN GENERAL HOSPITAL 401 EAST VAUGHN STREET RUSTON LA 71270 (318) 255-5780 300 190088 SPRINGHILL MEDICAL CENTER 2001 HUMANA DRIVE SPRINGHILL LA 71075 (318) 539-9161 590 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 55 Provider ID Hospital Name Address City State ZIP Telephone County 190089 RIVERLAND MEDICAL CENTER 1700 WALLACE BLVD FERRIDAY LA 71334 (318) 757-6551 140 190090 WINN PARISH MEDICAL CENTER 301 W BOUNDARY WINNFIELD LA 71483 (318) 628-2721 630 190095 BOGALUSA COMMUNITY MEDICAL CENTER 433 PLAZA BOGALUSA LA 70427 (504) 731-7122 580 190098 LSU HEALTH SCIENCES CENTER, SHREVEPORT 1541 KINGS HIGHWAY SHREVEPORT LA 71130 (318) 674-5000 80 190099 AVOYELLES HOSPITAL HIGHWAY 1192 BLUE TOWN ROAD MARKSVILLE LA 71351 (318) 253-8611 40 190102 OUR LADY OF LOURDES REG MED CENTER 611 ST LANDRY STREET LAFAYETTE LA 70506 (337) 234-7381 270 190106 OAKDALE COMMUNITY HOSPITAL 130 N HOSPITAL DR OAKDALE LA 71463 (318) 335-3700 10 190109 ST ANNE GENERAL HOSPITAL 4608 HWY 1 RACELAND LA 70394 (985) 537-6841 280 190110 ACADIA ST LANDRY PARISH HOSPITAL 810 S BROADWAY CHURCH POINT LA 70525 (337) 684-5435 0 190111 WILLIS KNIGHTON MEDICAL CENTER 2600 GREENWOOD ROAD SHREVEPORT LA 71103 (318) 632-4600 80 190114 HOMER MEMORIAL HOSPITAL 620 EAST COLLEGE STREET HOMER LA 71040 (318) 927-2024 130 190115 DOCTORS HOSPITAL OF SHREVEPORT 1130 LOUISIANA AVENUE SHREVEPORT LA 71101 (318) 227-1211 80 190116 MOREHOUSE GENERAL HOSPITAL 323 W WALNUT BASTROP LA 71221 (318) 283-3601 330 190118 DESOTO REGIONAL HEALTH SYSTEM 207 JEFFERSON STREET MANSFIELD LA 71052 (318) 872-4610 150 190122 EARL K LONG MEDICAL CENTER 5825 AIRLINE HIGHWAY BATON ROUGE LA 70805 (225) 358-1002 160 190124 PENDLETON MEMORIAL METHODIST HOSPITAL 5620 READ BOULEVARD NEW ORLEANS LA 70127 (504) 244-5474 350 190125 ST FRANCIS MEDICAL CENTER 309 JACKSON STREET MONROE LA 71210 (318) 327-4000 360 190128 WOMANS HOSPITAL 9050 AIRLINE HWY BATON ROUGE LA 70815 (225) 924-8104 160 190130 HARDTNER MEDICAL CENTER 1102 N PINE RD OLLA LA 71465 (318) 495-3131 290 190131 RIVER WEST MEDICAL CENTER 59355 RIVER WEST DRIVE PLAQUEMINE LA 70764 (225) 687-9222 230 190133 ALLEN PARISH HOSPITAL 108 6TH AVENUE KINDER LA 70648 (337) 738-2527 10 190135 MEMORIAL MEDICAL CENTER 2700 NAPOLEON AVENUE NEW ORLEANS LA 70115 (504) 899-9311 350 190140 FRANKLIN MEDICAL CENTER 2106 LOOP ROAD WINNSBORO LA 71295 (318) 435-9411 200 190144 MINDEN MEDICAL CENTER INC NO 1 MEDICAL PLAZA MINDEN LA 71055 (318) 377-2321 590 190145 LASALLE GENERAL HOSPITAL HWY 84 WEST JENA LA 71342 (318) 992-9200 290 190146 EAST JEFFERSON GENERAL HOSPITAL 4200 HOUMA BLVD METAIRIE LA 70011 (504) 454-4000 250 190147 HOOD MEMORIAL HOSPITAL 301 WALNUT STREET AMITE LA 70422 (985) 748-9485 520 190148 BUNKIE GENERAL HOSPITAL 427 EVERGREEN STREET BUNKIE LA 71322 (318) 346-6681 40 190149 RICHLAND PARISH HOSPITAL DELHI 407 CINCINNATI STREET DELHI LA 71232 (318) 878-6489 410 190151 RICHARDSON MEDICAL CENTER 254 HIGHWAY 3048 RAYVILLE LA 71269 (318) 728-4181 410 190152 MEADOWCREST HOSPITAL 2500 BELLE CHASSE HIGHWAY GRETNA LA 70056 (504) 392-3131 250 190156 MADISON PARISH HOSPITAL 900 JOHNSON STREET TALLULAH LA 71282 (318) 574-2374 320 190158 ST CHARLES GENERAL HOSPITAL 3700 ST CHARLES AVE NEW ORLEANS LA 70115 (504) 899-7441 350 190160 GLENWOOD REGIONAL MEDICAL CENTER 503 MCMILLAN ROAD WEST MONROE LA 71291 (318) 329-4200 360 190161 W O MOSS REGIONAL MEDICAL CENTER 1000 WALTERS STREET LAKE CHARLES LA 70605 (337) 475-8100 90 190162 ST CLAUDE MEDICAL CENTER 3419 ST CLAUDE AVENUE NEW ORLEANS LA 70117 (504) 948-8200 350 190164 BYRD REGIONAL HOSPITAL 1020 FERTITTA BLVD LEESVILLE LA 71446 (337) 239-9041 570 190167 VILLE PLATTE MEDICAL CENTER 800 E MAIN VILLE PLATTE LA 70586 (337) 363-5684 190 190175 RIVER PARISHES HOSPITAL 500 RUE DE SANTE LAPLACE LA 70068 (504) 277-7711 470 190176 TULANE UNIVERSITY HOSPITAL 1415 TULANE AVE NEW ORLEANS LA 70112 (504) 588-5215 350 190177 LAKEVIEW REGIONAL MEDICAL CENTER 95 EAST FAIRWAY CENTER DRIVE COVINGTON LA 70433 (504) 892-5900 510 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 56 Provider ID Hospital Name Address City State ZIP Telephone County 190182 LAKESIDE HOSPITAL 4700 I 10 SERVICE ROAD METAIRIE LA 70001 (504) 885-3333 250 190183 LEONARD J CHAUBERT MEDICAL CENTER 1978 INDUSTRIAL BLVD HOUMA LA 70360 (985) 873-2200 540 190184 CITIZENS MEDICAL CENTER HWY 165 SOUTH COLUMBIA LA 71418 (318) 649-6106 100 190185 CHALMETTE MEDICAL CENTER 9001 PATRICIA STREET CHALMETTE LA 70043 (504) 620-6000 430 190190 CALDWELL MEMORIAL HOSPITAL 410 MAIN STREET COLUMBIA LA 71418 (318) 649-6111 100 190191 DOCTORS HOSPITAL OF OPELOUSAS 3983 I 49 SOUTH SERVICE ROAD OPELOUSAS LA 70570 (337) 948-2100 480 190196 WOMEN'S AND CHILDREN'S HOSPITAL 4600 AMBASSADOR CAFFERY PKWY LAFAYETTE LA 70508 (337) 981-9100 270 190197 NORTH MONROE CENTER 3421 MEDICAL PARK DRIVE MONROE LA 71203 (318) 388-1946 360 190199 VILLA FELICIANA MEDICAL COMPLEX 5002 HIGHWAY 10 JACKSON LA 70748 (225) 634-4000 180 190200 LAKELAND MEDICAL CENTER 6000 BULLARD AVE NEW ORLEANS LA 70128 (504) 241-6335 350 190201 WOMEN AND CHILDREN'S HOSPITAL 4200 NELSON ROAD LAKE CHARLES LA 70605 (337) 474-6370 90 190202 SUMMIT HOSPITAL 17000 MEDICAL CENTER DR BATON ROUGE LA 70816 (225) 292-2470 160 190203 DOCTORS HOSPITAL OF JEFFERSON 4320 HOUMA BLVD METAIRIE LA 70006 (504) 456-5800 250 190204 NORTHSHORE REGIONAL MEDICAL CENTER 100 MEDICAL CENTER DRIVE SLIDELL LA 70461 (985) 649-7070 510 190205 MEDICAL CENTER OF SOUTHWEST LOUISIANA 2810 AMBASSADOR CAFFERY PARKWAY LAFAYETTE LA 70506 (337) 989-6700 270 190206 KENNER REGIONAL MEDICAL CENTER 180 W ESPLANADE AVENUE KENNER LA 70065 (504) 468-8600 250 190208 EAST CARROLL PARISH HOSPITAL 226 NORTH HOOD STREET LAKE PROVIDENCE LA 71254 (318) 559-4023 170 190218 SABINE MEDICAL CENTER 240 HIGHLAND DRIVE MANY LA 71449 (318) 256-5691 420 190236 WILLIS KNIGHTON BOSSIER HEALTH CENTER 2400 HOSPITAL DR BOSSIER CITY LA 71111 (318) 752-7000 70 190240 CHRISTUS COUSHATTA HEALTH CARE CENTER 1635 MARVEL ST COUSHATTA LA 71019 (318) 932-2199 400 190241 PHYSICIANS SURGICAL SPECIALTY HOSPITAL 218 CORPORATE DRIVE HOUMA LA 70360 (504) 853-1390 540 190242 ST ELIZABETH HOSPITAL 1125 WEST HIGHWAY 30 GONZALES LA 70737 (225) 765-5213 20 190245 MONROE SURGICAL HOSPITAL 2408 BROADMOOE BLVD MONROE LA 71201 (318) 410-0002 360 191300 ST HELENA PARISH HOSPITAL CAH HIGHWAY 43 NORTH GREENSBURG LA 70441 (225) 222-6111 450 191301 UNION GENERAL HOSPITAL 901 JAMES AVE FARMERVILLE LA 71241 (318) 368-9751 550 191302 ST MARTIN HOSPITAL 210 CHAMPAGNE STREET BREAUX BRIDGE LA 70517 (337) 332-2178 490 191303 ASSUMPTION COMMUNITY HOSPITAL 135 HIGHWAY 402 NAPOLEONVILLE LA 70390 (985) 369-3600 30 191304 NORTH CADDO MEDICAL CENTER 1000 SOUTH SPRUCE ST VIVIAN LA 71082 (318) 375-3235 80 191305 ST JAMES PARISH HOSPITAL 2471 LOUISIANA AVENUE LUTCHER LA 70071 (225) 869-5512 460 191306 WEST FELICIANA PARISH HOSPITAL CAH 5266 COMMERCE STREET SAINT FRANCISVILLE LA 70775 (225) 635-3811 620 191307 DEQUINCY MEMORIAL HOSPITAL 110 WEST 4TH STREET DEQUINCY LA 70633 (337) 786-1200 90 191308 PREVOST MEMORIAL HOSPITAL 301 MEMORIAL DR DONALDSONVILLE LA 70346 (225) 473-7931 20 192004 ASCENSION HOSPITAL 615 E WORTHY ROAD GONZALES LA 70737 (225) 621-1200 20 192006 SUMMITT HOSPITAL OF NORT LOUISIANA 4900 MEDICAL DRIVE BOSSIER CITY LA 71112 (318) 747-9500 70 192007 ADVANCE CARE HOSPITAL 1101 MEDICAL CENTER BLVD MARRERO LA 70072 (504) 349-2470 250 192008 DIXON MEDICAL CENTER 8375 FLORIDA BLVD DENHAM SPRINGS LA 70726 (225) 665-8211 310 192009 KENDRED HOSPITAL NEW ORLEANS 3601 COLISEUM STREET NEW ORLEANS LA 70115 (504) 899-1555 350 192010 LAGNIAPPE HOSPITAL 1800 IRVING PLACE SHREVEPORT LA 71101 (318) 425-4096 80 192011 LIFECARE HOSPITAL INC 9320 LINWOOD AVENUE SHREVEPORT LA 71106 (318) 222-2273 80 192012 DUBUIS HOSPITAL OF ALEXANDRIA 3330 MASONIC DR ALEXANDRIA LA 71301 (318) 448-4960 390 192013 SUMMIT INSTITUTE OF SW LOUISIANA 703 E CYPRESS STREET SULPHUR LA 70663 (337) 527-1102 90 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 57 Provider ID Hospital Name Address City State ZIP Telephone County 192014 GENESIS SPECIALTY HOSPITAL 301 NORTH JEFFERSON DAVIS PARKWAY 4TNEW ORLEANS LA 70119 (318) 263-2044 60 192015 LIFE CARE HOSPITAL OF NEW ORLEANS LLC 2700 NAPOLEAN AVENUE NEW ORLEANS LA 70115 (504) 896-5800 430 192016 ST FRANCIS SPECIALTY HOSPITAL 309 JACKSON STREET MONROE LA 71201 (318) 327-4267 360 192019 EXTENDED CARE OF SOUTHWEST LOUISIANA 2837 ERNEST BLDG B LAKE CHARLES LA 70601 (337) 436-6111 90 192020 COMMUNITY REHABILITATION OF LAFAYETTE 811 MARTIN LUTHER KING DRIVE LAFAYETTE LA 70501 (337) 285-0999 270 192022 HEALTHSOUTH NORTH REHAB HOSPITAL 1401 EZELL STREET RUSTON LA 71270 (318) 251-3126 300 192023 SPECIALTY HOSPITAL OF NEW ORLEANS 1401 FOUCHER STREET NEW ORLEANS LA 70115 (504) 897-8942 350 192024 DUBUIS HOSPITAL OF LAKE CHARLES 524 SOUTH RYAN STREET LAKE CHARLES LA 70601 (337) 491-7752 90 192025 DUBUIS HOSPITAL OF SHREVEPORT ONE ST MARY PLACE, 5TH & 6TH FLOORS SHREVEPORT LA 71101 (318) 678-1000 80 192026 BERNICE COMMUNITY HOSPITAL 100 MEADOWBROOK DRIVE MINDEN LA 71055 (318) 377-5555 550 192027 OASIS REHABILITATION HOSPITAL 4363 CONVENTION STREET BATON ROUGE LA 70806 (225) 383-6134 160 192028 PROFESSIONAL REHABILITATION HOSPITAL 6818 HIGHWAY 84 FERRIDAY LA 71334 (318) 757-7575 140 192029 REHABILITATION HOSP OF ACADIANA 310 YOUNGSVILLE HIGHWAY LAFAYETTE LA 70508 (337) 839-9880 270 192030 SELECT SPECIALTY HOSPITAL 4200 HOUMA BLVD METAIRIE LA 70006 (504) 480-5822 250 192031 SUMMIT HOSPITAL OF N LA AT W MONR,THE 6198 CYPRESS STREET MONROE LA 71203 (318) 747-9500 70 192032 OASIS REHABILITATION HOSPITAL OF LAFAY 2707 KALISTER SALOOM LAFAYETTE LA 70501 (337) 984-8878 270 192033 MEADOWBROOK REHABILITATION HOSPITAL 204 ENERGY PARKWAY LAFAYETTE LA 70508 (337) 232-1905 270 192035 SATELLITE REHAB HOSPITAL AT NATCHITOCH 501 KEYSER AVE 3RD FLOOR NATCHITOCHES LA 71457 (318) 354-2044 340 192036 HAMMOND REHABILITATION HOSPITAL 15719 BELL DRIVE HAMMOND LA 70403 (204) 902-9148 520 193028 REHAB HOSPITAL OF BATON ROUGE 8595 UNITED PLAZA BLVD BATON ROUGE LA 70809 (225) 927-0567 160 193031 HEALTHSOUTH REHAB HOSPITAL OF ALEXDRIA 104 N 3RD STREET ALEXANDRIA LA 71301 (318) 449-1370 90 193034 TOURO REHABILITATION CENTER 1401 FOUCHER STREET NEW ORLEANS LA 70115 (504) 897-8560 350 193044 NORTH OAKS REHAB HOSP INC 1900 S MORRISON BLVD HAMMOND LA 70403 (504) 542-7777 520 193047 VERMILION REHABILITATION HOSPITAL 118 N HOSPITAL DRIVE ABBEVILLE LA 70511 (337) 898-8800 480 193050 TRI PARISH REHABILITATION HOSPITAL 8088 HAWKS ROAD LEESVILLE LA 71446 (337) 825-9971 50 193052 BOGALUSA COMMUNITY REHAB HOSPITAL 433 PLAZA BOGALUSA LA 70427 (504) 732-1186 580 193053 COMMUNITY REHABILITATION HOSPITAL OF B 7414 SUMRALL DRIVE ROAD BATON ROUGE LA 70812 (225) 644-0173 20 193055 RIVERBEND REHABILITATION HOSPITAL 410 MAIN STREET COLUMBIA LA 71418 (318) 649-8774 100 193057 KAPLAN REHABILITATION HOSPITAL 1310 WEST 7TH STREET KAPLAN LA 70548 (402) 351-5687 560 193058 BASTROP REHABILITATION HOSPITAL 323 WEST WALNUT STREET BASTROP LA 71220 (318) 556-1191 330 193060 LULING REHABILITATION HOSPITAL 1125 PAUL MAILLARD LULING LA 70070 (504) 331-2281 440 193061 ST JOHN'S REHABILITATION HOSPITAL 405 FOLSE STREET HARAHAN LA 70123 (504) 738-7676 250 193064 LAPLACE REHABILITATION HOSPITAL 508 WEST 5TH STREET LA PLACE LA 70068 (504) 653-8447 350 193067 ACADIA REHABILITATION HOSPITAL 1305 CROWLEY RAYNE HWY CROWLEY LA 70527 (337) 785-2111 0 193069 STERLINGTON REHAB HOSPITAL 111 HIGHWAY 2 STERLINGTON LA 71280 (318) 665-9950 360 193070 BENTON REHABILITATION HOSPITAL 4660 COVENTION STREET BATON ROUGE LA 70802 (225) 336-1000 160 193071 CLINTON REHABILITATION HOSPITAL 9725 GRACE LANE CLINTON LA 70722 (225) 683-1600 180 193072 OASIS REHABILITATION HOSPITAL 1601 PERDIDO STREET 10TH FLOOR NEW ORLEANS LA 70112 (337) 983-0849 350 193073 ST LANDRY EXTENDED CARE HOSPITAL 539 E PRUDHOMME LANE OPELOUSAS LA 70571 (337) 233-1307 480 193074 HEALTHWEST REHABILITATION HOSPITAL 3201 WALL BLVD, SUITE B GRETNA LA 70056 (504) 433-5551 250 193075 RICHLAND PARISH REHABILITATION HOSPITA 307 HAYES STREET RAYVILLE LA 71269 (318) 728-4410 410 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 58 Provider ID Hospital Name Address City State ZIP Telephone County 193076 PREMIER PHYSICAL REHABILITATION HOSPIT 20050 CRESTWOOD BLVD COVINGTON LA 70433 (985) 871-1610 510 193077 ST ANNE REHAB HOSPITAL 4608 HIGHWAY 1 RACELAND LA 70394 (985) 537-7736 280 193078 SAGE REHABILITATION INSTITUTE 8225 SUMMA AVE BATON ROUGE LA 70809 (225) 819-0703 160 193079 UNITED MEDICAL REHABILITATION HOSPITAL 5650 READ BLVD NEW ORLEANS LA 70127 (504) 262-0421 350 193080 COMMUNITY REHABILITATION HOSPITAL COUS 1110 RINGGOLD AVE COUSHATTA LA 71019 (318) 932-1770 400 193081 LOUISIANA EXTENDED CARE HOSPITAL 1175 PINE STREET SUITE 200 ARCADIA LA 71001 (318) 263-9920 0 193300 CHILDRENS HOSPITAL 200 HENRY CLAY AVE NEW ORLEANS LA 70118 (504) 899-9511 350 194007 SOUTHEAST LOUISIANA HOSPITAL P O BOX 3850 MANDEVILLE LA 70448 (504) 626-6300 510 194008 EAST LOUISIANA STATE HOSPITAL HWY 10 E JACKSON LA 70748 (225) 634-2651 180 194012 NEW ORLEANS ADOLESCENT HOSPITAL 210 STATE STREET NEW ORLEANS LA 70118 (504) 897-3400 350 194019 NORTHSHORE PSYCHIATRIC HOSPITAL 104 MEDICAL CENTER DRIVE SLIDELL LA 70461 (504) 646-5500 510 194020 BRENTWOOD, A BEHAVIORAL HEALTH COMPANY 1006 HIGHLAND AVE SHREVEPORT LA 71106 (318) 688-3930 80 194022 CROSSROADS REGIONAL HOSPITAL 110 JOHN ESKEW DR ALEXANDRIA LA 71315 (318) 445-5111 390 194025 CENTRAL LOUISIANA STATE HOSPITAL 242 W SHAMROCK STREET PINEVILLE LA 71361 (318) 484-6200 390 194031 RIVER OAKS HOSPITAL 1525 RIVER OAKS WEST HARAHAN LA 70123 (504) 734-1740 250 194039 SAMARITAN HOSPITAL OF SHREVEPORT 453 JORDAN STREET SHREVEPORT LA 71105 (318) 424-6699 80 194042 RIVER OAKS CHILD & ADOLESCENT HOSPITAL 1525 RIVER OAKS ROAD WEST HARAHAN LA 70123 (504) 734-1740 250 194044 VERMILION HOSPITAL 2520 N UNIVERSITY AVENUE LAFAYETTE LA 70507 (337) 234-5614 270 194056 COMMUNITY CARE HOSPITAL 1421 GENERAL TAYLOR NEW ORLEANS LA 70115 (504) 899-2500 350 194060 ST PATRICKS PSYCHIATRIC HOSPITAL 309 JACKSON STREET MONROE LA 71210 (318) 327-4686 360 194063 ST JAMES PSYCHIATRIC HOSPITAL 2471 LOUISIANA AVE LUTCHER LA 70071 (800) 582-2985 460 194064 GREEN HILL HOSPITAL 960 HWY 171 SOUTH STONEWALL LA 71078 (318) 925-5565 150 194065 HEALTH PARADIGM MEDICAL CENTER 6990 HIGHWAY 80 RUSTON LA 71270 (318) 254-8433 300 200001 ST JOSEPH HOSPITAL 360 BROADWAY BANGOR ME 4401 (207) 262-1000 90 200002 MILES MEMORIAL HOSPITAL 35 MILES STREET DAMARISCOTTA ME 4543 (207) 563-1234 70 200003 MILLINOCKET REGIONAL HOSPITAL 200 SOMERSET ST MILLINOCKET ME 4462 (207) 723-5161 90 200007 BRIDGTON HOSPITAL SOUTH HIGHT STREET BRIDGTON ME 4009 (207) 647-6000 20 200008 MERCY HOSPITAL 144 STATE ST PORTLAND ME 4101 (207) 879-3000 20 200009 MAINE MEDICAL CENTER 22 BRAMHALL ST PORTLAND ME 4102 (207) 871-0111 20 200012 REDINGTON FAIRVIEW GENERAL HOSPITAL FAIRVIEW AVE SKOWHEGAN ME 4976 (207) 474-5121 120 200013 WALDO COUNTY GENERAL HOSPITAL 118 NORTHPORT AVENUE BELFAST ME 4915 (207) 338-2500 130 200016 RUMFORD HOSPITAL 420 FRANKLIN ST RUMFORD ME 4276 (207) 369-1000 80 200018 AROOSTOOK MEDICAL CENTER,THE 140 ACADEMY ST PRESQUE ISLE ME 4769 (207) 768-4000 10 200019 SOUTHERN MAINE MEDICAL CENTER 1 MEDICAL CENTER DRIVE BIDDEFORD ME 4005 (207) 283-7000 150 200020 YORK HOSPITAL 15 HOSPITAL DR YORK ME 3909 (207) 351-2139 150 200021 MID COAST HOSPITAL 123 MEDICAL CENTER DRIVE BRUNSWICK ME 4011 (207) 729-0181 20 200024 CENTRAL MAINE MEDICAL CENTER 300 MAIN ST LEWISTON ME 4240 (207) 795-0111 0 200025 PARKVIEW MEMORIAL HOSPITAL 329 MAIN STREET BRUNSWICK ME 4011 (207) 373-2000 20 200026 HOULTON REGIONAL HOSPITAL 20 HARTFORD ST HOULTON ME 4730 (207) 532-9471 10 200027 DOWN EAST COMMUNITY HOSPITAL UPPER COURT ST MACHIAS ME 4654 (207) 255-3356 140 200028 SEBASTICOOK VALLEY HOSPITAL 99 GROVE STREET PITTSFIELD ME 4967 (207) 487-5141 120 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 59 Provider ID Hospital Name Address City State ZIP Telephone County 200031 CARY MEDICAL CENTER 163 VAN BUREN RD, SUITE 1 CARIBOU ME 4736 (207) 498-3111 10 200032 STEPHENS MEMORIAL HOSPITAL 181 MAIN STREET NORWAY ME 4268 (207) 743-5933 80 200033 EASTERN MAINE MEDICAL CENTER 489 STATE ST BANGOR ME 4401 (207) 973-7000 90 200034 ST MARYS REGIONAL MEDICAL CENTER CAMPUS AVENUE LEWISTON ME 4240 (207) 777-8100 0 200037 FRANKLIN MEMORIAL HOSPITAL 111 FRANKLIN HEALTH COMMONS FARMINGTON ME 4938 (207) 778-6031 30 200039 MAINEGENERAL MEDICAL CENTER 149 NORTH STREET WATERVILLE ME 4901 (207) 872-1000 50 200040 HENRIETTA D GOODALL HOSPITAL 25 JUNE ST SANFORD ME 4073 (207) 324-4310 150 200041 INLAND HOSPITAL 200 KENNEDY MEMORIAL DRIVE WATERVILLE ME 4901 (207) 861-3000 50 200050 MAINE COAST MEMORIAL HOSPITAL 50 UNION ST ELLSWORTH ME 4605 (207) 667-5311 40 200052 NORTHERN MAINE MEDICAL CENTER 194 E MAIN ST FORT KENT ME 4743 (207) 834-3155 10 200063 PENOBSCOT BAY MEDICAL CENTER 6 GLEN COVE DRIVE ROCKPORT ME 4856 (207) 596-8000 60 200066 MAYO REGIONAL HOSPITAL 75 WEST MAIN ST DOVER FOXCROFT ME 4426 (207) 564-8401 100 201300 BLUE HILL MEMORIAL HOSPITAL WATER STREET BLUE HILL ME 4614 (207) 374-2836 10 201301 CHARLES A DEAN MEMORIAL HOSPITAL PRITHAM AVENUE PO BOX 1129 GREENVILLE ME 4441 (207) 695-5215 100 201302 ST ANDREWS HOSPITAL 6 ST ANDREWS LANE BOOTHBAY HARBOR ME 4538 (207) 633-2121 70 201303 PENOBSCOT VALLEY HOSPITAL TRANSALPINE ROAD,BOX 368 LINCOLN ME 4457 (207) 794-3321 70 201304 MOUNT DESERT ISLAND HOSPITAL 10 WAYMAN LANE, PO BOX 8 BAR HARBOR ME 4609 (207) 288-5081 40 201305 CALAIS REGIONAL HOSPITAL 50 FRANKLIN STREET CALAIS ME 4619 (207) 454-7521 140 201306 RUMFORD HOSPITAL 420 FRANKLIN STREET RUMFORD ME 4276 (207) 369-1000 80 203025 NEW ENGLAND REHAB HOSPITAL OF PORTLAND 335 BRIGHTON AVENUE, UNIT 201 PORTLAND ME 4102 (207) 775-4000 20 204004 BANGOR MENTAL HEALTH INSTITUTE 656 STATE ST BANGOR ME 4401 (207) 941-4000 90 204005 SPRING HARBOR HOSPITAL 175 RUNNING HILL ROAD SOUTH PORTLAND ME 4106 (207) 761-2200 20 204006 ACADIA HOSPITAL,THE 268 STILLWATER AVE BANGOR ME 4401 (207) 973-6100 90 204007 AUGUSTA MENTAL HEALTH INSTITUTE ARSENAL ST P O BOX 724 AUGUSTA ME 4330 (207) 287-7200 50 210001 WASHINGTON COUNTY HOSPITAL KING & ANTIETAM STS HAGERSTOWN MD 21740 (301) 790-8000 210 210002 UNIVERSITY OF MARYLAND MED SYSTM 22 S GREENE ST BALTIMORE MD 21201 (410) 328-8667 30 210003 PRINCE GEORGES HOSPITL CENTER 3001 HOSPITAL DRIVE CHEVERLY MD 20785 (301) 618-2000 160 210004 HOLY CROSS HOSPITAL 1500 FOREST GLEN ROAD SILVER SPRING MD 20910 (301) 754-7000 150 210005 FREDERICK MEMORIAL HOSPITAL 400 WEST SEVENTH ST FREDERICK MD 21701 (301) 698-3300 100 210006 HARFORD MEMORIAL HOSP 501 S UNION AVE HAVRE DE GRACE MD 21078 (410) 939-2400 120 210007 ST JOSEPH HOSPITAL 7601 OSLER DRIVE TOWSON MD 21285 (410) 337-1000 20 210008 MERCY MEDICAL CENTER INC 301 ST PAUL PLACE BALTIMORE MD 21202 (410) 332-9000 30 210009 JOHNS HOPKINS HOSP 600 N WOLFE ST BALTIMORE MD 21287 (410) 955-6387 30 210010 DORCHESTER GENL HOSP 300 BYRN ST BOX 439 CAMBRIDGE MD 21613 (410) 228-5511 90 210011 ST AGNES HOSPITAL WILKENS & CATON AVENUES BALTIMORE MD 21229 (410) 368-6000 30 210012 SINAI HOSPITAL 2401 WEST BELVEDERE AVE BALTIMORE MD 21215 (410) 601-9000 30 210013 BON SECOURS HOSP 2000 W BALTIMORE STREET BALTIMORE MD 21223 (410) 362-3000 30 210015 FRANKLIN SQUARE HOSPITAL 9000 FRANKLIN SQUARE DR BALTIMORE MD 21237 (443) 777-7000 20 210016 WASHINGTON ADVENTIST HOSP 7600 CARROLL AVE TAKOMA PARK MD 20912 (301) 891-7600 150 210017 GARRETT COUNTY MEMORIAL HOSPITAL 251 N FOURTH ST OAKLAND MD 21550 (301) 533-4000 110 210018 MONTGOMERY GENERAL HOSPITAL INC 18101 PRINCE PHILIP DRIVE OLNEY MD 20832 (301) 774-8882 150 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 60 Provider ID Hospital Name Address City State ZIP Telephone County 210019 PENINSULA GENL HOSP 100 E CARROLL AVE SALISBURY MD 21801 (301) 546-6400 220 210022 SUBURBAN HOSPITAL ASSOCIATION 8600 OLD GEORGETOWN RD BETHESDA MD 20814 (301) 896-3100 150 210023 ANNE ARUNDEL MEDICAL CENTER 2001 MEDICAL PARKWAY ANNAPOLIS MD 21401 (443) 481-3000 10 210024 UNION MEMORIAL HOSPITAL 201 E UNIVERSITY PKY BALTIMORE MD 21218 (410) 554-2000 30 210025 MEMORIAL HOSP & MED CTR CUMBERLAND 600 MEMORIAL AVE CUMBERLAND MD 21502 (301) 723-4000 0 210026 CHURCH HOSPITAL CORPORATION 100 N BROADWAY BALTIMORE MD 21231 (410) 522-8000 30 210027 SACRED HEART HOSPITAL 900 SETON DRIVE CUMBERLAND MD 21502 (301) 723-4200 0 210028 ST MARYS HOSPITAL PO BOX 527 LEONARDTOWN MD 20650 (301) 475-8981 180 210029 JOHNS HOPKINS BAYVIEW MEDICAL CENTER 4940 EASTERN AVENUE BALTIMORE MD 21224 (410) 550-0100 30 210030 KENT & QUEEN ANNES HOSPITAL 100 BROWN ST CHESTERTOWN MD 21620 (410) 778-3300 140 210032 UNION HOSPITAL-CECIL COUNTY 106 BOW STREET ELKTON MD 21921 (410) 398-4000 70 210033 CARROLL COUNTY GENERAL HOSPITAL 200 MEMORIAL AVE WESTMINSTER MD 21157 (410) 871-6902 60 210034 HARBOR HOSPITAL CENTER 3001 S HANOVER STREET BALTIMORE MD 21230 (410) 350-3200 30 210035 CIVISTA MEDICAL CENTER 701 E CHARLES STREET LA PLATA MD 20646 (301) 609-4000 80 210037 MEMORIAL HOSPITAL AT EASTON 219 S WASHINGTON ST EASTON MD 21601 (410) 822-1000 200 210038 MARYLAND GENL HOSP 827 LINDEN AVE BALTIMORE MD 21201 (410) 225-8000 30 210039 CALVERT MEMORIAL HOSP 100 HOSPITAL ROAD PRINCE FREDERICK MD 20678 (410) 535-4000 40 210040 NORTHWEST HOSPITAL CENTER 5401 OLD COURT RD RANDALLSTOWN MD 21133 (410) 521-2200 20 210043 NORTH ARUNDEL HOSP 301 HOSPITAL DR GLEN BURNIE MD 21061 (410) 787-4000 10 210044 GREATER BALTIMORE MEDICAL CENTER 6701 N CHARLES ST BALTIMORE MD 21204 (410) 828-2121 20 210045 EDWARD MCCREADY MEMORIAL HOSPITAL 201 HALL HIGHWAY CRISFIELD MD 21817 (410) 968-1200 190 210048 HOWARD COUNTY GENERAL HOSPITAL 5755 CEDAR LANE COLUMBIA MD 21044 (410) 740-7890 130 210049 UPPER CHESAPEAKE MEDICAL CENTER 500 UPPER CHESAPEAKE DRIVE BEL AIR MD 21014 (443) 643-1000 120 210051 DOCTOR'S COMMUNITY HOSPITAL 8118 GOOD LUCK ROAD LANHAM MD 20706 (301) 552-8118 160 210054 SOUTHERN MARYLAND HOSP 7503 SURRATTS RD CLINTON MD 20735 (201) 868-8000 160 210055 LAUREL REGIONAL HOSPITAL 7300 VAN DUSEN ROAD LAUREL MD 20707 (301) 725-4300 160 210056 GOOD SAMARITAN HOSPITAL 5601 LOCH RAVEN BLVD BALTIMORE MD 21239 (410) 532-8000 30 210057 SHADY GROVE ADVENTIST HOSP 9901 MEDICAL CTR DR ROCKVILLE MD 20850 (301) 279-6000 150 210058 JAMES LAWRENCE KERNAN HOSPITAL INC 2200 KERNAN DRIVE BALTIMORE MD 21207 (410) 448-2500 20 210060 FT WASHINGTON MEDICAL CENTER 11711 LIVINGSTON ROAD FORT WASHINGTON MD 20744 (301) 292-7000 160 210061 ATLANTIC GENERAL HOSPITAL 9733 HEALTHWAY DRIVE BERLIN MD 21811 (410) 641-1100 230 212002 WESTERN MD CENTER 1500 PENNSYLVANIA AVE HAGERSTOWN MD 21742 (301) 791-4400 210 212003 DEER'S HEAD CENTER 315 DEER'S HEAD HOSPITAL ROAD SALISBURY MD 21802 (410) 543-4000 220 212005 LEVINDALE HEBREW GERI CTR 2434 W BELVEDERE AVENUE BALTIMORE MD 21215 (301) 466-8700 30 212007 UNIVERSITY SPECIALTY HOSPITAL 611 S CHARLES ST BALTIMORE MD 21230 (410) 547-8500 30 213027 EASTERN NEURO REHABILITATION HOSPITAL 2105 FAIRLAND ROAD SILVER SPRING MD 20904 (301) 989-2000 150 213028 HEALTHSOUTH CHESAPEAKE REHAB HOSPITAL 220 TILGHMAN ROAD SALISBURY MD 21801 (410) 546-4600 220 213029 KESSLER ADVENTIST REHABILITATION 9909 MEDICAL CENTER DRIVE ROCKVILLE MD 20850 (240) 864-6000 150 213300 MT WASHINGTON PEDIATRIC HOSP 1708 W ROGERS AVE BALTIMORE MD 21209 (410) 578-8600 30 213301 KENNEDY KREIGER INSTITUTE 707 N BROADWAY BALTIMORE MD 21205 (443) 923-9200 30 214000 SHEPPARD ENOCH PRATT HOSPITAL, THE 6501 N CHARLES STREET PO BOX 6815 TOWSON MD 21204 (410) 938-3000 20 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 61 Provider ID Hospital Name Address City State ZIP Telephone County 214001 CROWNSVILLE HOSPITAL CENTER 1520 CROWNSVILLE ROAD CROWNSVILLE MD 21032 (401) 729-6000 10 214002 EASTERN SHORE HOSPITAL CENTER ROUTE 2 PO BOX 800 CAMBRIDGE MD 21613 (410) 221-2300 90 214003 BROOK LANE PSYCHIATRIC CENTER 13218 BROOK LANE DRIVE HAGERSTOWN MD 21740 (301) 733-0330 210 214004 SPRINGFIELD HOSPITAL CENTER 6655 SYKESVILLE ROAD SYKESVILLE MD 21784 (410) 795-2100 60 214011 WALTER P CARTER CENTER 630 W FAYETTE STREET BALTIMORE MD 21201 (410) 209-6201 30 214012 THOMAS B FINAN CENTER COUNTRY CLUB ROAD PO BOX 1722 CUMBERLAND MD 21502 (301) 777-2405 0 214013 POTOMAC RIDGE BEHAVIORAL HEALTH C 14901 BROSCHART ROAD ROCKVILLE MD 20850 (301) 251-4500 150 214018 SPRING GROVE HOSPITAL CENTER WADE AVENUE CATONSVILLE MD 21228 (410) 402-7181 20 214019 UPPER SHORE COMMUNITY MENTAL HEALTH CT SCHEELER ROAD PO BOX 229 CHESTERTOWN MD 21620 (410) 778-6800 140 220001 HEALTH ALLIANCE HOSPITALS INC 60 HOSPITAL ROAD LEOMINSTER MA 1453 (508) 343-5000 170 220002 MT AUBURN HOSP 330 MT AUBURN ST CAMBRIDGE MA 2138 (617) 492-3500 90 220003 ATHOL MEMORIAL HOSPITAL 2033 MAIN STREET ATHOL MA 1331 (508) 249-3511 170 220006 SALEM HOSPITAL CORPORATION,THE 81 HIGHLAND AVENUE SALEM MA 1970 (508) 741-1200 40 220008 STURDY MEMORIAL HOSPITAL 211 PARK STREET ATTLEBORO MA 2703 (508) 222-5200 20 220010 LAWRENCE GENERAL HOSPITAL ONE GENERAL STREET LAWRENCE MA 1842 (508) 683-4000 40 220011 CAMBRIDGE HOSPITAL 1493 CAMBRIDGE ST CAMBRIDGE MA 2138 (617) 498-1000 90 220012 CAPE COD HOSPITAL P O BOX 640, 27 PARK STREET HYANNIS MA 2601 (617) 771-1800 0 220015 COOLEY DICKINSON HOSPITAL INC,THE 30 LOCUST ST NORTHAMPTON MA 1060 (413) 582-2000 80 220016 FRANKLIN MEDICAL CENTER 164 HIGH ST GREENFIELD MA 1301 (413) 772-0211 60 220017 CARNEY HOSPITAL 2100 DORCHESTER AVE BOSTON MA 2124 (617) 296-4000 160 220019 HARRINGTON MEMORIAL HOSPITAL 100 SOUTH ST SOUTHBRIDGE MA 1550 (508) 765-9771 170 220020 ST ANNES HOSPITAL CORPORATION 795 MIDDLE ST FALL RIVER MA 2722 (508) 674-5741 20 220024 HOLYOKE HOSPITAL INC 575 BEECH ST HOLYOKE MA 1040 (413) 534-2500 70 220025 HUBBARD REGIONAL HOSPITAL 340 THOMPSON ROAD WEBSTER MA 1570 (508) 943-2600 170 220028 ST VINCENT HOSPITAL 25 WINTHROP STREET WORCESTER MA 1604 (508) 798-1234 170 220029 ANNA JAQUES HOSPITAL 25 HIGHLAND AVE NEWBURYPORT MA 1950 (508) 463-1000 40 220030 WING MEMORIAL HOSPITAL WRIGHT ST PALMER MA 1069 (413) 283-7651 70 220031 BOSTON MED CTR CORP/UNIVE HOSP CAMPUS 1 BOSTON MEDICAL CENTER PLACE BOSTON MA 2118 (617) 638-8000 160 220033 BEVERLY HOSPITAL HERRICK & HEATHER STS BEVERLY MA 1915 (508) 922-3000 40 220035 UNION HOSPITAL 500 LYNNFIELD STREET LYNN MA 1904 (781) 581-9200 40 220036 ST ELIZABETHS MEDICAL CENTER OF BOSTON 736 CAMBRIDGE ST BRIGHTON MA 2135 (617) 789-3000 160 220038 FAIRVIEW HOSPITAL 29 LEWIS AVE GREAT BARRINGTON MA 1230 (413) 528-0790 10 220046 BERKSHIRE MEDICAL CENTER INC 725 NORTH STREET PITTSFIELD MA 1201 (413) 447-2000 10 220049 MARLBOROUGH HOSPITAL 57 UNION ST MARLBOROUGH MA 1752 (508) 485-1121 90 220050 MARY LANE HOSPITAL 85 SOUTH ST WARE MA 1082 (413) 967-6211 80 220051 NORTH ADAMS REGIONAL HOSPITAL HOSPITAL AVE NORTH ADAMS MA 1247 (413) 663-3701 10 220052 BROCKTON HOSPITAL 680 CENTER STREET BROCKTON MA 2402 (508) 941-7000 150 220058 CLINTON HOSPITAL ASSOCIATION 201 HIGHLAND ST CLINTON MA 1510 (508) 365-4531 170 220060 JORDAN HOSPITAL INC 275 SANDWICH STREET PLYMOUTH MA 2360 (508) 830-2005 150 220062 ADCARE HOSPITAL OF WORCESTER INC 107 LINCOLN ST WORCESTER MA 1605 (508) 799-9000 170 220063 LOWELL GENERAL HOSPITAL 295 VARNUM AVENUE LOWELL MA 1854 (508) 937-6350 90 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 62 Provider ID Hospital Name Address City State ZIP Telephone County 220065 NOBLE HOSPITAL 115 W SILVER ST WESTFIELD MA 1085 (413) 568-2811 70 220066 MERCY HOSPITAL, INC 271 CAREW STREET SPRINGFIELD MA 1104 (413) 748-9331 70 220067 QUINCY MEDICAL CENTER 114 WHITWELL STREET QUINCY MA 2169 (617) 733-6100 130 220070 HALLMARK HEALTH SYSTEM 100 HOSPITAL ROAD MALDEN MA 2148 (617) 396-9250 90 220071 MASSACHUSETTS GENERAL HOSPITAL FRUIT ST BOSTON MA 2114 (617) 726-2000 160 220073 MORTON HOSPITAL & MEDICAL CENTER 88 WASHINGTON ST TAUNTON MA 2780 (508) 824-6911 20 220074 SOUTHCOAST HOSPITAL GROUP INC 363 HIGHLAND AVENUE FALL RIVER MA 2720 (508) 295-0880 150 220075 MASSACHUSETTS EYE AND EAR INFIRMARY 243 CHARLES ST BOSTON MA 2114 (617) 523-7900 160 220076 DEACONESS-WALTHAM HOSPITAL HOPE AVE WALTHAM MA 2454 (617) 647-6000 90 220077 BAYSTATE MEDICAL CENTER 759 CHESTNUT ST SPRINGFIELD MA 1107 (413) 784-0000 70 220079 CARITAS SOUTHWOOD HOSPITAL 111 DEDHAM STREET NORFOLK MA 2056 (508) 668-0385 130 220080 HOLY FAMILY HOSPITAL & MEDICAL CENTER 70 EAST ST METHUEN MA 1844 (508) 687-0151 40 220081 NANTUCKET COTTAGE HOSPITAL S PROSPECT ST NANTUCKET MA 2554 (508) 228-1200 120 220082 SAINTS MEMORIAL MEDICAL CENTER INC 220 PAWTUCKET STREET LOWELL MA 1852 (508) 458-1411 90 220083 DEACONESS-GLOVER HOSPITAL CORP 148 CHESTNUT ST NEEDHAM MA 2494 (617) 444-5600 130 220084 EMERSON HOSPITAL OLD RD TO 9 ACRE CORNER W CONCORD MA 1742 (508) 369-1400 90 220086 BETH ISRAEL DEACONESS MEDICAL CENTER 330 BROOKLINE AVE BOSTON MA 2215 (617) 667-7000 160 220088 NEW ENGLAND BAPTIST HOSPITAL 125 PARKER HILL AVENUE BOSTON MA 2120 (617) 738-5800 160 220089 METROWEST MEDICAL CENTER 115 LINCOLN STREET FRAMINGHAM MA 1701 (508) 383-1000 90 220090 MILFORD WHITINSVILLE REG HOSPITAL 14 PROSPECT STREET MILFORD MA 1757 (508) 473-1190 130 220095 HEYWOOD HOSPITAL 242 GREEN STREET GARDNER MA 1440 (508) 632-3420 170 220098 DEACONESS - NASHOBA HOSPITAL 200 GROTON AVE AYER MA 1432 (508) 772-0200 90 220100 SOUTH SHORE HOSPITAL 55 FOGG RD SOUTH WEYMOUTH MA 2190 (617) 337-7011 130 220101 NEWTON-WELLESLEY HOSPITAL 2014 WASHINGTON ST NEWTON MA 2462 (617) 243-6000 90 220105 WINCHESTER HOSPITAL 41 HIGHLAND AVE WINCHESTER MA 1890 (617) 729-9000 90 220108 MILTON MEDICAL CENTER 92 HIGHLAND ST MILTON MA 2186 (617) 696-4600 130 220110 BRIGHAM AND WOMANS HOSPITAL 75 FRANCIS ST BOSTON MA 2115 (617) 732-5500 160 220111 CARITAS GOOD SAMARITAN MED CTR 235 N PEARL ST BROCKTON MA 2301 (508) 427-3000 130 220116 NEW ENGLAND MEDICAL CTR HOSPITALS INC 750 WASHINGTON STREET BOSTON MA 2111 (617) 956-5000 160 220119 FAULKNER HOSPITAL 1153 CENTRE ST BOSTON MA 2130 (617) 522-5800 160 220126 CARITAS NORWOOD HOSPITAL, INC 800 WASHINGTON STREET NORWOOD MA 2062 (617) 769-4000 130 220133 STILLMAN INFIRMARY-HARVARD UNIV 75 MOUNT AUBURN STREET CAMBRIDGE MA 2138 (617) 495-2074 90 220135 FALMOUTH HOSPITAL 67&100 TER HEUN DR FALMOUTH MA 2540 (508) 548-5300 0 220153 SOLDIERS HOME OF HOLYOKE CHERRY ST HOLYOKE MA 1040 (413) 532-9475 70 220154 QUIGLEY MEMORIAL HOSPITAL 91 CREST AVE CHELSEA MA 2150 (617) 884-5660 160 220162 DANA-FARBER CANCER INSTITUTE 44 BINNEY ST BOSTON MA 2115 (617) 632-3000 160 220163 UMASS MEMORIAL MED CTR-UNIVERSITY CAMP 55 LAKE AVENUE NORTH WORCESTER MA 1605 (508) 856-4174 170 220171 MARY AND ARTHUR CLAPHAM HOSPITAL 41 MALL ROAD BURLINGTON MA 1803 (617) 273-8500 90 220172 UNIVERSITY HEALTH SERVICES UNIVERSITY OF MASSACHUSETTS AMHERST MA 1002 (413) 549-2671 80 220174 MERRIMACK VALLEY HOSPITAL 140 LINCOLN AVENUE HAVERHILL MA 1830 (978) 521-8134 40 221300 MARTHA'S VINEYARD HOSPITAL LINTON LANE OAK BLUFFS MA 2557 (508) 693-0410 30 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 63 Provider ID Hospital Name Address City State ZIP Telephone County 221990 CHESTNUT HILL BENEVOLENT ASSOCIATION 910 BOYLSTON STREET BOSTON COLLEGE MA 2467 (617) 734-5600 0 222000 YOUVILLE REHAB CHRONIC DISEASE HOSP 1575 CAMBRIDGE ST CAMBRIDGE MA 2138 (617) 876-4344 90 222002 NORTHEAST SPECIALTY HOSP BRAINTREE 2001 WASHINGTON STREET BRAINTREE MA 2184 (508) 947-1000 150 222003 TEWKSBURY HOSP 365 EAST STREET TEWKSBURY MA 1876 (508) 851-7321 90 222006 LEMUEL SHATTUCK HOSP 170 MORTON ST JAMAICA PLAIN MA 2130 (617) 522-8110 160 222007 HEBREW REHABILITATION CENTER FOR AGED 1200 CENTRE STREET BOSTON MA 2131 (617) 325-8000 160 222010 JEWISH MEMORIAL HOSPITAL 59 TOWNSEND ST BOSTON MA 2119 (617) 442-8760 160 222023 WESTERN MASSACHUSETTS HOSP 91 EAST MOUNTAIN ROAD WESTFIELD MA 1085 (413) 562-4131 70 222024 OLYMPUS SPECIALTY HOSPITAL 775 TRAPELO ROAD WALTHAM MA 2154 (617) 894-4600 90 222025 MASSACHUSETTS HOSPITAL SCHOOL 3 RANDOLPH STREET CANTON MA 2021 (617) 828-2440 130 222026 SHAUGHNESSY-KAPLAN REHAB HOSP HOSP DOVE AVENUE SALEM MA 1970 (508) 745-9000 40 222027 NEW ENGLAND SINIAI HOSP & REHAB CENTER 150 YORK ST STOUGHTON MA 2072 (617) 364-4850 130 222035 SPAULDING REHAB HOSP 125 NASHUA ST BOSTON MA 2114 (617) 720-6400 160 222042 WORCESTER COUNTY HOSPITAL PAUL WARE DRIVE BOYLSTON MA 1505 (508) 852-1533 170 222043 SUNHEALTH SPECIALTY HOSPITAL OF SOE MA 4499 ACUSHNET AVE NEW BEDFORD MA 2745 (508) 995-6900 20 222044 VENCOR HOSPITAL NORTH SHORE 15 KING ST PEABODY MA 1960 (508) 531-2900 40 222045 KINDRED HOSPITAL - BOSTON 1515 COMMONWEALTH AVE BOSTON MA 2135 (617) 254-1100 160 222046 PARK VIEW SPECIALTY HOSPITAL 1400 STATE STREET SPRINGFIELD MA 1109 (413) 787-6700 70 223026 NEW ENGLAND REHAB HOSP 2 REHABILITATION WAY WOBURN MA 1801 (617) 935-5050 90 223027 HEALTHSOUTH BRAINTREE REHAB HOSPITAL 250 POND ST BRAINTREE MA 2184 (781) 848-5353 130 223028 WHITTIER REHABILITATION HOSP 76 SUMMER ST HAVERHILL MA 1830 (508) 372-8000 40 223029 FAIRLAWN REHABILITATION HOSPITAL 189 MAY ST WORCESTER MA 1602 (617) 791-6351 170 223030 HEALTHSOUTH HOSP OF WESTERN MA 14 CHESTNUT PLACE LUDLOW MA 1056 (413) 583-8820 70 223032 REHAB HOSP OF THE CAPE AND ISLANDS 311 SERVICE ROAD EAST SANDWICH MA 2537 (508) 833-8200 0 223033 WHITTIER REHAB HOSPITAL-WESTBOROUGH 150 FLANDERS ROAD WESTBOROUGH MA 1581 (508) 871-2000 170 223300 FRANCISCAN CHILDRENS HOSP & REHAB CTR 30 WARREN ST BRIGHTON MA 2135 (617) 254-3800 160 223302 CHILDRENS HOSPITAL,THE 300 LONGWOOD AVENUE BOSTON MA 2115 (617) 735-6000 160 224001 TAUNTON STATE HOSP 60 HODGES AVENUE, BOX 151 TAUNTON MA 2780 (508) 824-7551 20 224007 MCLEAN HOSPITAL CORPORATION 115 MILL ST BELMONT MA 2478 (617) 855-3450 90 224013 ARBOR,THE 49 ROBINWOOD AVE BOSTON MA 2130 (617) 522-4400 160 224017 DR HARRY SOLOMON MHC 391 VARNUM AVE LOWELL MA 1854 (508) 454-8851 90 224018 HUMAN RESOURCE INST OF BOSTON 227 BABCOCK STREET BROOKLINE MA 2146 (617) 731-3200 130 224021 FULLER MEMORIAL HOSPITAL 231 WASHINGTON STREET SOUTH ATTLEBORO MA 2703 (508) 761-8500 20 224022 BOURNEWOOD HOSPITAL 300 SOUTH STREET BROOKLINE MA 2146 (617) 469-0300 90 224023 WESTWOOD PEMBROKE HEALTH SYSTEMS 45 CLAPBOARDTREE ST WESTWOOD MA 2090 (617) 762-7764 130 224025 QUINCY MENTAL HEALTH CENTER 460 QUINCY AVE QUINCY MA 2169 (617) 626-9000 130 224026 WESTBOROUGH ST HOSP DANIELS BLDG LYMAN ST PO BOX 288 WESTBOROUGH MA 1581 (508) 366-4401 170 224028 DR JOHN C CORRIGAN MENTAL HEALTH CTR 49 HILLSIDE ST FALL RIVER MA 2720 (508) 678-2901 20 224030 MEDFIELD STATE HOSPITAL 45 HOSPITAL RD MEDFIELD MA 2052 (617) 727-9830 130 224031 CAPE COD & ISLANDS MENTAL HLTH CTR 830 COUNTY RD POCASSET MA 2559 (508) 563-2276 0 224032 WORCESTER STATE HOSPITAL 305 BELMONT STREET WORCESTER MA 1604 (508) 752-4681 170 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 64 Provider ID Hospital Name Address City State ZIP Telephone County 224033 BALDPATE HOSPITAL BALDPATE ROAD GEORGETOWN MA 1833 (508) 352-2131 40 224035 CHARLES RIVER HOSPITAL 203 GROVE ST WELLESLEY MA 2181 (781) 416-5300 130 224036 DR SOLOMON CARTER FULLER M H CENTER 85 EAST NEWTON STREET BOSTON MA 2118 (617) 266-8800 160 224037 ERICH LINDEMANN MENTAL HEALTH CENTER 25 STANIFORD STREET BOSTON MA 2114 (617) 727-5500 160 230001 BELL MEMORIAL HOSPITAL 101 S 4TH ST ISHPEMING MI 49849 (906) 486-4431 510 230002 ST MARY MERCY HOSPITAL 36475 FIVE MILE ROAD LIVONIA MI 48154 (517) 000-0000 810 230003 ZEELAND COMMUNITY HOSPITAL 100 S PINE ST ZEELAND MI 49464 (616) 772-4644 690 230004 MERCY GENERAL HEALTH PARTNERS 1500 E SHERMAN BOULEVARD MUSKEGON MI 49443 (616) 739-9341 600 230005 EMMA L BIXBY MEDICAL CENTER 818 RIVERSIDE AVE ADRIAN MI 49221 (517) 263-0711 450 230006 HAYES GREEN BEACH MEMORIAL HOSPITAL 321 HARRIS STREET CHARLOTTE MI 48813 (517) 543-1050 220 230012 RENAISSANCE HOSP AND MED CENTERS 801 VIRGINIA PARK DETROIT MI 48202 (313) 874-2800 810 230013 NORTH OAKLAND MEDICAL CENTERS 461 W HURON ST PONTIAC MI 48341 (313) 857-7222 620 230015 THREE RIVERS AREA HOSPITAL 1111 WEST BROADWAY THREE RIVERS MI 49093 (616) 278-1145 740 230017 BRONSON METHODIST HOSPITAL 601 JOHN STREET KALAMAZOO MI 49007 (616) 383-7654 380 230019 PROVIDENCE HOSPITAL 16001 W NINE MILE RD SOUTHFIELD MI 48037 (313) 424-3000 620 230020 OAKWOOD HOSPITAL AND MEDICAL CENTER 18101 OAKWOOD BLVD DEARBORN MI 48123 (313) 593-7000 810 230021 LAKELAND HOSPITAL, ST JOSEPH 1234 NAPIER AVENUE SAINT JOSEPH MI 49085 (616) 983-8305 100 230022 COMMUNITY HEALTH CTR OF BRANCH COUNTY 274 E CHICAGO ST COLDWATER MI 49036 (517) 279-5489 110 230024 SINAI-GRACE HOSPITAL 6071 W OUTER DR DETROIT MI 48235 (313) 493-5010 810 230027 IONIA COUNTY MEMORIAL HOSPITAL 479 LAFAYETTE ST IONIA MI 48846 (616) 527-4200 330 230029 ST JOSEPH MERCY OAKLAND 44405 WOODWARD AVENUE PONTIAC MI 48341 (313) 858-3000 620 230030 GRATIOT COMMUNITY HOSPITAL 300 WARWICK DRIVE ALMA MI 48801 (517) 463-1101 280 230031 MERCY HOSPITAL 2601 ELECTRIC AVENUE PORT HURON MI 48060 (313) 985-1500 730 230034 CHEBOYGAN MEMORIAL HOSPITAL 748 S MAIN CHEBOYGAN MI 49721 (616) 627-5601 150 230035 UNITED MEMORIAL HOSPITAL 615 S BOWER STREET GREENVILLE MI 48838 (616) 754-4691 580 230036 ALPENA GENERAL HOSPITAL 1501-1511 W CHISHOLM ST ALPENA MI 49707 (517) 356-7390 30 230037 HILLSDALE COMMUNITY HEALTH CENTER 168 S HOWELL STREET HILLSDALE MI 49242 (517) 437-4451 290 230038 SPECTRUM HEALTH-DOWNTOWN CAMPUS 100 MICHIGAN ST-N E GRAND RAPIDS MI 49503 (616) 774-1774 400 230040 PENNOCK HOSPITAL 1009 W GREEN ST HASTINGS MI 49058 (616) 945-3451 70 230041 BAY REGIONAL MEDICAL CENTER 1900 COLUMBUS AVE BAY CITY MI 48706 (517) 894-3000 80 230042 ALLEGAN GENERAL HOSPITAL 555 LINN ST ALLEGAN MI 49010 (616) 673-8424 20 230046 UNIVERSITY OF MICHIGAN HEALTH SYSTEM 1500 E MEDICAL CENTER DRIVE ANN ARBOR MI 48104 (313) 764-1505 800 230047 ST JOSEPHS MERCY HOSPITAL & HLTH SVCS 15855 NINETEEN MILE RD CLINTON TOWNSHIP MI 48038 (810) 263-2300 490 230053 HENRY FORD HOSPITAL 2799 W GRAND BLVD DETROIT MI 48202 (313) 876-8068 810 230054 MARQUETTE GENERAL HOSPITAL 420 WEST MAGNETIC STREET MARQUETTE MI 49855 (906) 228-9440 510 230055 DICKINSON COUNTY MEMORIAL HOSPITAL 1721 S STEPHENSON AVE IRON MOUNTAIN MI 49801 (906) 774-1313 210 230058 MERCY HOSPITAL 1100 MICHIGAN AVE GRAYLING MI 49738 (517) 348-5461 190 230059 SAINT MARY'S MERCY MEDICAL CENTER 200 JEFFERSON SE GRAND RAPIDS MI 49503 (616) 752-6838 400 230060 WEST SHORE MEDICAL CENTER 1465 E PARKDALE AVENUE MANISTEE MI 49660 (231) 398-1000 500 230065 ST JOHN NORTHEAST COMM HOSPITAL 4777 E OUTER DRIVE DETROIT MI 48234 (313) 369-9100 810 230066 HACKLEY HOSPITAL 1700 CLINTON STREET MUSKEGON MI 49443 (616) 728-4952 600 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 65 Provider ID Hospital Name Address City State ZIP Telephone County 230069 SAINT JOSEPH MERCY LIVINGSTON HOSPITAL 620 BYRON RD HOWELL MI 48843 (517) 546-1410 460 230070 ST LUKES HOSPITAL 705 COOPER SAGINAW MI 48602 (517) 771-6100 720 230071 STRAITH HOSPITAL FOR SPECIAL SURGERY 23901 LAHSER SOUTHFIELD MI 48034 (313) 357-3360 620 230072 HOLLAND COMMUNITY HOSPITAL 602 MICHIGAN AVE HOLLAND MI 49423 (616) 392-5141 690 230075 BATTLE CREEK HEALTH SYSTEM 300 NORTH AVENUE BATTLE CREEK MI 49016 (616) 966-8002 120 230077 ST MARY'S MEDICAL CENTER 800 S WASHINGTON AVENU SAGINAW MI 48601 (517) 776-8176 720 230078 COMMUNITY HOSPITAL MEDICAL PARK DR WATERVLIET MI 49098 (616) 463-3111 100 230080 CENTRAL MICHIGAN COMMUNITY HOSPITAL 1221 SOUTH DRIVE MOUNT PLEASANT MI 48858 (517) 772-6700 360 230081 MERCY HOSPITAL-CADILLAC 400 HOBART CADILLAC MI 49601 (616) 779-7200 830 230082 MARLETTE COMMUNITY HOSPITAL 2770 MAIN STREET MARLETTE MI 48453 (517) 635-4000 750 230085 SOUTH HAVEN COMMUNITY HOSPITAL 955 S BAILEY AVE SOUTH HAVEN MI 49090 (616) 637-5271 790 230086 SPECTRUM HLTH-REED CITY CAMPUS 300 N PATTERSON ROAD REED CITY MI 49677 (616) 832-3271 660 230089 BON SECOURS HOSPITAL 468 CADIEUX RD GROSSE POINTE MI 48230 (313) 343-1000 810 230092 W A FOOTE MEMORIAL HOSPITAL 205 N EAST AVE JACKSON MI 49201 (517) 788-4800 370 230093 MECOSTA COUNTY GENERAL HOSPITAL 405 WINTER BIG RAPIDS MI 49307 (616) 796-8691 530 230095 WEST BRANCH REGIONAL MEDICAL CENTER 2463 SOUTH M-30 WEST BRANCH MI 48661 (517) 345-3660 640 230096 STURGIS HOSPITAL 916 MYRTLE AVE STURGIS MI 49091 (616) 651-7824 740 230097 MUNSON MEDICAL CENTER 1105 SIXTH STREET TRAVERSE CITY MI 49684 (231) 935-5000 270 230099 MERCY-MEMORIAL HOSPITAL 740 N MACOMB STREET, PO BOX 67 MONROE MI 48161 (313) 242-7581 570 230100 TAWAS ST JOSEPH HOSPITAL 200 HEMLOCK TAWAS CITY MI 48763 (517) 362-3411 340 230101 ST FRANCIS HOSPITAL 3401 LUDINGTON ST ESCANABA MI 49829 (906) 786-3311 200 230103 CLINTON MEMORIAL HOSPITAL 805 S OAKLAND SAINT JOHNS MI 48879 (517) 224-6881 180 230104 HARPER UNIVERSITY HOSPITAL 3990 JOHN R STREET DETROIT MI 48201 (313) 745-9095 810 230105 NORTHERN MICHIGAN HOSPITAL 416 CONNABLE AVE PETOSKEY MI 49770 (616) 348-4000 230 230106 GERBER MEMORIAL HOSPITAL 212 S SULLIVAN ST FREMONT MI 49412 (616) 924-3300 610 230108 PORTAGE HEALTH SYSTEM 500 CAMPUS DRIVE HANCOCK MI 49930 (906) 483-1000 300 230110 MEMORIAL MED CENTER OF WEST MICHIGAN ONE ATKINSON DRIVE LUDINGTON MI 49431 (231) 845-2384 520 230117 BORGESS-PIPP HEALTH CENTER 1521 GULL ROAD KALAMAZOO MI 49048 (616) 383-5916 380 230118 HURON MEDICAL CENTER 1100 SOUTH VAN DYKE ROAD BAD AXE MI 48413 (989) 269-9521 310 230119 ST JOHN DETROIT RIVERVIEW HOSPITAL 7733 E JEFFERSON DETROIT MI 48214 (313) 499-4100 810 230120 HERRICK MEMORIAL HOSPITAL 500 E POTTAWATAMIE ST TECUMSEH MI 49286 (517) 423-2141 450 230121 MEMORIAL HEALTHCARE CENTER 826 WEST KING STREET OWOSSO MI 48867 (517) 723-5211 770 230124 CHARLEVOIX AREA HOSPITAL LAKE SHORE DRIVE CHARLEVOIX MI 49720 (616) 547-4024 140 230125 BERRIEN GENERAL HOSPITAL 6418 DEANS HILL RD BERRIEN CENTER MI 49102 (616) 471-7761 100 230130 WILLIAM BEAUMONT HOSPITAL 3601 W 13 MILE ROAD ROYAL OAK MI 48073 (313) 288-8000 620 230132 HURLEY MEDICAL CENTER 1 HURLEY PLAZA FLINT MI 48502 (810) 257-9131 240 230133 OTSEGO MEMORIAL HOSPITAL 825 N CENTER ST GAYLORD MI 49735 (517) 731-2100 680 230135 COTTAGE HOSPITAL 159 KERCHEVAL AVENUE GROSSE POINTE FARM MI 48236 (313) 884-8600 810 230141 MCLAREN REGIONAL MEDICAL CENTER 401 BALLENGER HWY FLINT MI 48532 (313) 762-2345 240 230142 OAKWOOD ANNAPOLIS HOSPITAL 33155 ANNAPOLIS AVE WAYNE MI 48184 (313) 467-4174 810 230143 GRAND VIEW HOSPITAL N10561 GRAND VIEW LANE IRONWOOD MI 49938 (906) 932-2525 260 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 66 Provider ID Hospital Name Address City State ZIP Telephone County 230144 OAKWOOD HOSPITAL BEYER CENTER 135 S PROSPECT ST YPSILANTI MI 48198 (313) 484-2200 800 230145 KEWEENAW MEMORIAL MEDICAL CENTER 205 OSCEOLA STREET LAURIUM MI 49913 (906) 337-3100 300 230146 HENRY FORD WYANDOTTE HOSPITAL 2333 BIDDLE AVE WYANDOTTE MI 48192 (313) 184-2400 810 230149 IRON COUNTY GENERAL HOSPITAL 1400 W ICE LAKE RD IRON RIVER MI 49935 (906) 265-6121 350 230151 BOTSFORD GENERAL HOSPITAL 28050 GRAND ST FARMINGTON MI 48024 (313) 471-8666 620 230153 EATON RAPIDS MEDICAL CENTER 1500 SOUTH MAIN STREET EATON RAPIDS MI 48827 (517) 663-2671 220 230155 KELSEY MEMORIAL HOSPITAL 418 WASHINGTON AVE LAKEVIEW MI 48850 (517) 352-7211 580 230156 ST JOSEPH MERCY HOSPITAL 5301 E HURON RIVER DR ANN ARBOR MI 48106 (313) 573-3456 800 230165 ST JOHN HOSPITAL & MEDICAL CTR 22101 MOROSS RD DETROIT MI 48236 (313) 343-4000 810 230167 INGHAM REGIONAL MEDICAL CENTER 401 W GREENLAWN AVE LANSING MI 48910 (517) 334-2967 320 230169 RIVERSIDE OSTEOPATHIC HOSPITAL 150 TRUAX STREET TRENTON MI 48183 (313) 676-4200 810 230171 LAKESHORE COMMUNITY HOSPITAL 72 S STATE ST SHELBY MI 49455 (616) 861-2156 630 230172 LAKEVIEW COMMUNITY HOSPITAL 408 HAZEN ST BOX 209 PAW PAW MI 49079 (616) 657-3141 790 230174 NORTH OTTAWA COMMUNITY HOSPITAL 1309 SHELDON RD GRAND HAVEN MI 49417 (616) 842-3600 690 230176 OAKWOOD SOUTHSHORE MEDICAL CENTER 5450 FORT STREET TRENTON MI 48183 (313) 671-3802 810 230180 MIDMICHIGAN MEDICAL CENTER-CLARE 104 WEST SIXTH STREET CLARE MI 48617 (517) 386-5101 170 230184 DOCTORS HOSPITAL OF JACKSON 110 N ELM AVENUE JACKSON MI 49202 (517) 787-1440 370 230186 MADISON COMMUNITY HOSPITAL 30671 STEPHENSON HIGHWAY MADISON HEIGHTS MI 48071 (248) 588-8000 620 230188 HILLS AND DALE GENERAL HOSPITAL 4675 HILL ST CASS CITY MI 48726 (517) 872-2121 780 230189 MIDMICHIGAN MEDICAL CENTER-GLADWIN 515 QUARTER STREET GLADWIN MI 48624 (517) 426-9286 250 230190 BRONSON VICKSBURG HOSPITAL 13326 NORTH BLVD VICKSBURG MI 49097 (616) 649-2321 380 230193 LAPEER REGIONAL HOSPITAL 1375 N MAIN ST LAPEER MI 48446 (313) 664-1441 430 230195 ST JOHN MACOMB HOSPITAL 11800 EAST TWELVE MILE ROAD WARREN MI 48093 (313) 572-5100 490 230197 GENESYS REG MED CTR-FLINT OSTEO CAMPUS 3921 BEECHER RD FLINT MI 48502 (810) 606-5000 240 230199 LEE MEMORIAL HOSPITAL 420 WEST HIGH STREET DOWAGIAC MI 49047 (616) 782-8681 130 230204 BI-COUNTY COMMUNITY HOSPITAL 13355 E TEN MILE RD WARREN MI 48089 (313) 759-7300 490 230207 PONTIAC OSTEOPATHIC HOSPITAL 50 NORTH PERRY PONTIAC MI 48341 (313) 338-5000 230208 CARSON CITY HOSPITAL ELM AT 3RD ST CARSON CITY MI 48811 (517) 584-3131 580 230212 SAINT JOSEPH MERCY SALINE HOSPITAL 400 RUSSELL ST SALINE MI 48176 (313) 429-1500 800 230216 PORT HURON HOSPITAL 1001 KEARNEY STREET PORT HURON MI 48060 (313) 987-5000 730 230217 OAKLAWN HOSPITAL 200 N MADISON MARSHALL MI 49068 (616) 781-4271 120 230222 MIDMICHIGAN MEDICAL CENTER-MIDLAND 4005 ORCHARD DRIVE MIDLAND MI 48640 (517) 839-3000 550 230223 ST JOHN HEALTH SYSTEM OAKLAND GENERAL 27351 DEQUINDRE MADISON HEIGHTS MI 48071 (313) 967-7000 620 230227 MT CLEMENS GENERAL HOSPITAL 1000 HARRINGTON BLVD MOUNT CLEMENS MI 48043 (313) 466-8090 490 230230 EDWARD W SPARROW HOSPITAL ASSOCIATION 1215 E MICHIGAN AVENUE LANSING MI 48912 (517) 483-2505 320 230235 CARO COMMUNITY HOSPITAL 401 N HOOPER ST, BOX 71 CARO MI 48723 (517) 673-3141 780 230236 METROPOLITIAN HOSPITAL 1919 BOSTON S E GRAND RAPIDS MI 49506 (616) 247-7200 400 230239 CHIPPEWA COUNTY WAR MEM HOSPITAL 500 OSBORN BLVD SAULT SAINTE MARIE MI 49783 (906) 635-4460 160 230241 ST JOHN RIVER DISTRICT HOSPITAL 4100 SOUTH RIVER ROAD EAST CHINA MI 48054 (313) 329-7111 730 230244 GARDEN CITY OSTEOPATHIC HOSPITAL 6245 NORTH INKSTER RD GARDEN CITY MI 48135 (313) 421-3300 810 230254 CRITTENTON HOSPITAL 1101 W UNIVERSITY DRIVE COLUMBUS MI 48063 (313) 652-5200 730 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 67 Provider ID Hospital Name Address City State ZIP Telephone County 230257 ST JOHN NORTH SHORES HOSPITAL 26755 BALLARD ROAD HARRISON TOWNSHIP MI 48045 (313) 465-5501 490 230259 CHELSEA COMMUNITY HOSPITAL 775 S MAIN ST CHELSEA MI 48118 (734) 475-3932 800 230264 KERN HOSPITAL 21230 DEQUINDRE ROAD WARREN MI 48091 (313) 759-4520 490 230269 WILLIAM BEAUMONT HOSPITAL 44201 DEQUINDRE TROY MI 48098 (248) 828-6201 620 230270 OAKWOOD HERITAGE HOSPITAL 10000 TELEGRAPH ROAD TAYLOR MI 48180 (313) 295-5000 810 230273 DETROIT REC HOSP & UNIV HLTH CENTER 4201 ST ANTOINE DETROIT MI 48201 (313) 745-3102 810 230275 HEALTHSOURCE SAGINAW 3340 HOSPITAL ROAD SAGINAW MI 48608 (517) 790-1234 720 230277 HURON VALLEY-SINAI HOSPITAL 1 WILLIAM CARLS DRIVE COMMERCE MI 48382 (313) 360-3300 620 230279 BRIGHTON HOSPITAL 12851 E GRAND RIVER BRIGHTON MI 48116 (810) 227-1211 460 230283 KINDRED HOSPITAL - METRO DETROIT 2700 MARTIN LUTHER KING JR BLVD DETROIT MI 48208 (313) 361-8000 810 230285 SCCI HOSPITAL - DETROIT 15000 GRATIOT DETROIT MI 48205 (313) 372-2200 810 230290 SELECT SPECIALTY HOSPITAL-PONTIAC 4405 WOODWARD AVENUE, 8TH FLOOR PONTIAC MI 48341 (248) 452-5200 620 230292 SELECT SPECIALTY HOSPITAL-SAGINAW 1447 N HARRISON, 7TH FLOOR SAGINAW MI 48602 (989) 583-4667 720 231300 PAUL OLIVER MEMORIAL HOSPITAL 224 PARK AVE FRANKFORT MI 49635 (231) 352-9621 90 231301 KALKASKA MEMORIAL HEALTH CENTER 419 S CORAL, BOX 249 KALKASKA MI 49646 (231) 258-7500 390 231302 LEELANAU MEMORIAL HEALTH CENTER 215 S HIGH ST NORTHPORT MI 49670 (231) 386-0000 440 231303 SCHOOLCRAFT MEMORIAL HOSPITAL 500 MAIN ST MANISTIQUE MI 49854 (906) 341-3200 760 231304 HELEN NEWBERRY JOY HOSPITAL 502 W HARRIE ST NEWBERRY MI 49868 (906) 293-9200 470 231305 STANDISH COMMUNITY HOSPITAL 805 W CEDAR ST STANDISH MI 48658 (517) 846-4521 50 231306 MACKINAC STRAITS HOSPITAL 220 BURDETTE ST SAINT IGNACE MI 49781 (906) 643-8585 480 231307 BARAGA COUNTY MEMORIAL HOSPITAL 770 N MAIN ST L' ANSE MI 49946 (906) 524-3300 60 231308 MUNISING MEMORIAL HOSPITAL 1500 SAND POINT RD MUNISING MI 49862 (906) 387-4110 10 231309 ONTONAGON MEMORIAL HOSPITAL 601 SEVENTH ST ONTONAGON MI 49953 (906) 884-4134 650 231310 SCHEURER HOSPITAL 170 N CASEVILLE RD PIGEON MI 48755 (989) 453-3223 310 231311 DECKERVILLE COMMUNITY HOSPITAL 3559 PINE ST DECKERVILLE MI 48427 (810) 376-2835 750 231312 SHERIDAN COMMUNITY HOSPITAL 301 N MAIN ST SHERIDAN MI 48884 (989) 291-3261 580 231313 HARBOR BEACH COMMUNITY HOSPITAL 210 S FIRST ST HARBOR BEACH MI 48441 (517) 479-3201 310 231314 MCKENZIE MEMORIAL HOSPITAL 120 DELAWARE STREET SANDUSKY MI 48471 (810) 648-3770 750 232012 SELECT SPECIALTY HOSPITAL-FLINT ONE HURLEY PLAZA, SUITE 115 FLINT MI 48503 (810) 762-7200 240 232019 KINDRED HOSPITAL - DETROIT 26400 W OUTER DR LINCOLN PARK MI 48146 (313) 368-2000 810 232020 BAY SPECIAL CARE CENTER 3250 E MIDLAND RD, SUITE 1 BAY CITY MI 48706 (517) 667-6801 80 232021 SELECT SPECIALTY HOSPITAL-WESTERN MICH 1700 CLINTON STREET-SUITE 2S MUSKEGON MI 49443 (616) 728-5647 600 232023 SELECT SPECIALTY HOSP-MACOMB CTY INC 215 NORTH AVE, SUITE 200 MOUNT CLEMENS MI 48043 (810) 307-9000 490 232024 SELECT SPECIALTY HOSPITAL-ANN ARBOR 5301 E HURON RIVER DR, 6TH FL YPSILANTI MI 48197 (734) 712-0500 800 232025 LAKELAND SPECIALTY HOSP AT BERRIEN CTR 6418 DEANS HILL RD BERRIEN CENTER MI 49102 (616) 471-7761 100 232026 LIFECARE HOSPITALS OF WESTERN MICHIGAN 1700 OAK AVE MUSKEGON MI 49442 (616) 777-6202 600 232028 SELECT SPECIALTY HOSPITAL-BATTLE CREEK 300 NORTH AVE, FLOOR 6 BATTLE CREEK MI 49016 (616) 565-8002 120 232029 SPECTRUM HEALTH-KENT COMMUNITY CAMP 750 FULLER AVE NE GRAND RAPIDS MI 49503 (616) 336-3901 400 232031 SELECT SPECIALTY HOSPITAL-WYANDOTTE 2333 BIDDLE AVENUE WYANDOTTE MI 48192 (734) 324-3571 810 232032 SELECT SPECIALTY HOSPITAL - NW DETROIT 6071 WEST OUTER DRIVE DETROIT MI 48235 (810) 345-0000 810 233025 SOUTHWESTERN MICHIGAN REHAB HOSP 183 WEST STREET BATTLE CREEK MI 49017 (616) 965-3206 120 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 68 Provider ID Hospital Name Address City State ZIP Telephone County 233026 MARY FREE BED HOSPTIAL 235 WEALTHY SE GRAND RAPIDS MI 49503 (616) 242-0300 400 233027 REHABILITATION INSTITUTE 261 MACK BLVD DETROIT MI 48201 (313) 745-9816 810 233028 GREAT LAKES REGIONAL REHAB HOSPITAL 22401 FOSTER WINTER DR SOUTHFIELD MI 48075 (313) 569-1500 620 233029 ROGERS CITY REHABILITATION HOSPITAL 555 N BRADLEY HIGHWAY ROGERS CITY MI 49779 (517) 734-7545 700 233300 CHILDREN'S HOSPITAL OF MICHIGAN 3901 BEAUBIEN DETROIT MI 48201 (313) 993-8754 810 234006 PINE REST CHRISTIAN HOSPITAL 300 - 68TH STREET, SE GRAND RAPIDS MI 49548 (616) 455-5000 400 234011 HENRY FORD - KINGSWOOD HOSPITAL 10300 W EIGHT MILE ROAD FERNDALE MI 48220 (248) 398-3200 620 234021 HARBOR OAKS HOSPITAL 35031 23 MILE RD NEW BALTIMORE MI 48047 (586) 725-5777 490 234023 HAVENWYCK HOSPITAL 1525 UNIVERSITY DRIVE AUBURN HILLS MI 48326 (248) 373-9200 620 234025 CARO CENTER 2000 CHAMBERS, BOX A CARO MI 48723 (517) 673-3191 780 234026 KALAMOZOO REGIONAL PSYCHIATRIC HOSP 1312 OAKLAND DR KALAMAZOO MI 49008 (616) 337-3000 380 234028 HORIZON HEALTHCARE, INC 3737 HUMBOLDT DETROIT MI 48208 (313) 361-7650 810 234030 FOREST VIEW PSYCHIATRIC HOSPITAL 1055 MEDICAL PARK SE GRAND RAPIDS MI 49546 (616) 942-9610 400 234034 NORTHVILLE REGIONAL PSYCHIATRIC HOSP 41001 SEVEN MILE RD NORTHVILLE MI 48167 (248) 349-1800 810 234035 WALTER P REUTHER PSYCHIATRIC HOSPITAL 30901 PALMER RD WESTLAND MI 48185 (734) 722-4500 810 240001 NORTH MEMORIAL MEDICAL CENTER 3300 OAKDALE NORTH ROBBINSDALE MN 55422 (612) 520-5200 260 240002 ST MARYS MEDICAL CENTER 407 E 3RD ST DULUTH MN 55805 (218) 726-4000 680 240004 HENNEPIN COUNTY MEDICAL CENTER 701 PARK AVENUE MINNEAPOLIS MN 55415 (612) 347-2990 260 240006 OLMSTED MEDICAL CENTER 1650 4TH STREET SE ROCHESTER MN 55904 (507) 285-8485 540 240007 WEINER MEMORIAL MEDICAL CENTER 300 SOUTH BRUCE STREET MARSHALL MN 56258 (507) 532-9661 410 240010 ST MARYS HOSPITAL 1216 2ND ST SW ROCHESTER MN 55902 (507) 285-5123 540 240011 GLENCOE AREA HEALTH CENTER 705 E 18TH ST GLENCOE MN 55336 (320) 864-3121 420 240013 ST GABRIELS HOSPITAL 815 SOUTHEAST SECOND STREET LITTLE FALLS MN 56345 (320) 632-5441 480 240014 NORTHFIELD CITY HOSPITAL 800 W 2ND ST NORTHFIELD MN 55057 (507) 645-6661 650 240016 ST JOSEPHS HOSPITAL 600 PLEASANT AVE PARK RAPIDS MN 56470 (218) 732-3311 280 240017 NORTHWEST MEDICAL CENTER 120 LABREE AVE S THIEF RIVER FALLS MN 56701 (218) 681-4240 560 240018 FAIRVIEW RED WING MEDICAL CENTER 701 FAIRVIEW BOULEVARD, PO BOX 95 RED WING MN 55066 (612) 388-6721 290 240019 MILLER DWAN MEDICAL CENTER 502 E SECOND ST DULUTH MN 55805 (218) 720-1113 680 240020 CAMBRIDGE MEDICAL CENTER 701 SOUTH DELLWOOD CAMBRIDGE MN 55008 (612) 689-7700 290 240021 MINNESOTA VALLEY MEMORIAL HOSPITAL 621 SOUTH FOURTH STREET LE SUEUR MN 56058 (612) 665-3375 390 240022 WORTHINGTON REGIONAL HOSPITAL 1018 6TH AVE, PO BOX 997 WORTHINGTON MN 56187 (507) 372-2941 520 240025 TRI COUNTY HOSPITAL 418 N JEFFERSON WADENA MN 56482 (218) 631-3510 790 240027 GLACIAL RIDGE HOSPITAL 10 FOURTH AVENUE SOUTHEAST GLENWOOD MN 56334 (320) 634-4521 600 240029 ST FRANCIS MEDICAL CENTER 415 OAK STREET BRECKENRIDGE MN 56520 (218) 643-3000 830 240030 DOUGLAS COUNTY HOSPITAL 111 17TH AVENUE EAST ALEXANDRIA MN 56308 (612) 762-1511 200 240031 ST MICHAEL'S HOSPITAL 425 NORTH ELM STREET SAUK CENTRE MN 56378 (320) 352-2221 720 240036 ST CLOUD HOSPITAL 1406 6TH AVE NORTH SAINT CLOUD MN 56303 (612) 251-2700 720 240037 QUEEN OF PEACE HOSPITAL 301 2ND ST NE NEW PRAGUE MN 56071 (612) 758-4431 390 240038 UNITED HOSPITALS INC 333 NORTH SMITH SAINT PAUL MN 55102 (612) 298-8888 610 240040 UNIVERSITY MEDICAL CENTER-MESABI 750 EAST 34TH ST HIBBING MN 55746 (218) 362-6655 680 240043 NAEVE HOSPITAL 404 FOUNTAIN STREET ALBERT LEA MN 56007 (507) 373-2384 230 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 69 Provider ID Hospital Name Address City State ZIP Telephone County 240044 COMMUNITY MEMORIAL HOSPITAL 855 MANKATO AVENUE, PO BOX 5600 WINONA MN 55987 (507) 454-3650 840 240045 COMMUNITY MEMORIAL HOSPITAL 512 SKYLINE BOULEVARD CLOQUET MN 55720 (218) 879-4641 80 240047 ST LUKES HOSPITAL OF DULUTH 915 E 1ST ST DULUTH MN 55805 (218) 726-5555 680 240050 FAIRVIEW LAKES REGIONAL MEDICAL CENTER 5200 FAIRVIEW BLVD WYOMING MN 55092 (612) 464-3341 810 240052 LAKE REGION HOSPITAL 712 SO CASCADE FERGUS FALLS MN 56537 (218) 736-5475 550 240053 METHODIST HOSPITAL 6500 EXCELSIOR BLVD SAINT LOUIS PARK MN 55426 (612) 993-5010 260 240056 RIDGEVIEW MEDICAL CENTER 500 S MAPLE ST WACONIA MN 55387 (612) 442-2191 90 240057 ABBOTT - NORTHWESTERN HOSPITAL INC 800 EAST 28TH STREET MINNEAPOLIS MN 55407 (612) 863-4000 260 240059 REGINA MEDICAL COMPLEX 1175 NININGER ROAD HASTINGS MN 55033 (612) 437-3121 180 240061 ROCHESTER METHODIST HOSPITAL 201 W CENTER ST ROCHESTER MN 55902 (507) 286-7004 540 240063 ST JOSEPHS HOSPITAL 69 WEST EXCHANGE STREET SAINT PAUL MN 55102 (612) 291-3122 610 240064 ITASCA MEMORIAL CENTER 126 1ST AVE S E GRAND RAPIDS MN 55744 (218) 326-3401 300 240066 LAKEVIEW MEMORIAL HOSPITAL 927 WEST CHURCHILL STREET STILLWATER MN 55082 (651) 439-5330 810 240069 OWATONNA HOSPITAL 903 SOUTH OAK STREET OWATONNA MN 55060 (507) 451-3850 730 240071 RICE COUNTY DISTRICT ONE HOSPITAL 631 1ST ST SE FARIBAULT MN 55021 (507) 334-6451 650 240075 ST JOSEPHS MEDICAL CENTER 523 NORTH 3RD STREET BRAINERD MN 56401 (218) 829-2861 170 240076 BUFFALO HOSPITAL 303 CATLIN ST BUFFALO MN 55313 (763) 682-1212 850 240077 SIOUX VALLEY CANBY CAMPUS 112 ST OLAF AVE S CANBY MN 56220 (507) 223-7277 860 240078 FAIRVIEW SOUTHDALE HOSPITAL 6401 FRANCE AVENUE SOUTH EDINA MN 55435 (952) 924-5000 260 240079 FIRST CARE MEDICAL SERVICES 900 SOUTH HILLIGOSS BLVD EAST FOSSTON MN 56542 (218) 435-1133 590 240080 FAIRVIEW UNIVERSITY MEDICAL CENTER 2450 RIVERSIDE AVENUE MINNEAPOLIS MN 55454 (612) 273-6150 260 240083 NEW ULM MEDICAL CENTER 1324 FIFTH NORTH STREET NEW ULM MN 56073 (507) 354-2111 70 240084 VIRGINIA REGIONAL MEDICAL CENTER 901 9TH ST N VIRGINIA MN 55792 (218) 741-3340 680 240087 STEVENS COMMUNITY MEMORIAL HOSPITAL 400 E 1ST ST MORRIS MN 56267 (320) 589-1313 740 240088 RICE MEMORIAL HOSPITAL 301 BECKER AVE SW WILLMAR MN 56201 (320) 235-4543 330 240089 CANNON FALLS COMMUNITY HOSPITAL 1116 WEST MILL STREET CANNON FALLS MN 55009 (507) 263-4221 240 240093 IMMANUEL-ST JOSEPHS-MAYO HEALTH SYSTEN 1025 MARSH STREET, PO BOX 8673 MANKATO MN 56002 (507) 345-2646 60 240094 MONTICELLO-BIG LAKE COMM HOSPITAL 1013 HART BOULEVARD MONTICELLO MN 55362 (612) 295-2945 850 240100 NORTH COUNTRY REGIONAL HOSPITAL 1100 W 38TH ST BEMIDJI MN 56601 (218) 751-5430 30 240101 ST MARYS REGIONAL HEALTH CENTER 1027 WASHINGTON AVE DETROIT LAKES MN 56501 (218) 847-5611 20 240103 MEMORIAL HOSPITAL 665 3RD ST SW PERHAM MN 56573 (218) 346-4500 550 240104 ST FRANCIS REGIONAL MEDICAL CENTER 1455 ST FRANCIS SHAKOPEE MN 55379 (612) 445-2322 690 240106 REGIONS HOSPITAL 640 JACKSON STREET SAINT PAUL MN 55101 (612) 221-2191 610 240107 SWIFT COUNTY-BENSON HOSPITAL 1815 WISCONSIN AVE BENSON MN 56215 (320) 843-4232 750 240109 ELEAH MEDICAL CENTER 930 FIRST STREET NORTHEAST ELBOW LAKE MN 56531 (218) 685-4461 250 240115 MERCY HOSPITAL 4050 COON RAPIDS BLVD COON RAPIDS MN 55433 (612) 427-2200 10 240117 AUSTIN MEDICAL CENTER 1000 FIRST DRIVE NORTHWEST AUSTIN MN 55912 (507) 437-4551 490 240121 MERCY HOSPITAL 710 SOUTH KENWOOD AVENUE, BOX 469 MOOSE LAKE MN 55767 (218) 485-4481 80 240122 PAYNESVILLE AREA HOSPITAL 200 FIRST STREET WEST PAYNESVILLE MN 56362 (320) 243-3767 720 240123 PIPESTONE COUNTY MED CTR & ASHTON CC PO BOX 370, 911 FIFTH AVE SOUTHWEST PIPESTONE MN 56164 (507) 825-5811 580 240124 REDWOOD AREA HOSPITAL 100 FALLWOOD RD REDWOOD FALLS MN 56283 (507) 637-2907 630 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 70 Provider ID Hospital Name Address City State ZIP Telephone County 240128 LUVERNE COMMUNITY HOSPITAL 305 EAST LUVERNE STREET LUVERNE MN 56156 (507) 283-2321 660 240132 UNITY HOSPITAL 550 OSBORNE ROAD FRIDLEY MN 55432 (612) 786-2200 10 240133 MEEKER COUNTY MEMORIAL HOSPITAL 612 SOUTH SIBLEY AVE LITCHFIELD MN 55355 (320) 693-3242 460 240137 CUYUNA REGIONAL MEDICAL CENTER 320 EAST MAIN STREET CROSBY MN 56441 (218) 546-7000 170 240139 MILLE LACS HEALTH SYSTEM 200 NORTH ELM ST ONAMIA MN 56359 (320) 532-8020 470 240141 FAIRVIEW NORTHLAND REGIONAL HOSPITAL 704 NORTHLAND DRIVE PRINCETON MN 55371 (612) 389-1313 470 240143 MADISON HOSPITAL 820 THIRD AVENUE MADISON MN 56256 (320) 598-7556 360 240145 TYLER HEALTHCARE CENTER, INC 240 WILLOW STREET TYLER MN 56178 (507) 247-5521 400 240146 WASECA AREA MEMORIAL HOSPITAL 100 5TH AVE NW WASECA MN 56093 (507) 835-1210 800 240152 KANABEC HOSPITAL 300 CLARK STREET MORA MN 55051 (612) 679-1212 320 240154 DEER RIVER HEALTHCARE CENTER 1002 COMSTOCK DRIVE DEER RIVER MN 56636 (218) 246-3022 300 240162 UNITED HOSPITAL DISTRICT 515 S MOORE ST BLUE EARTH MN 56013 (507) 526-3273 210 240166 FAIRMONT COMMUNITY HOSPITAL 835 JOHNSON STREET, PO BOX 835 FAIRMONT MN 56031 (507) 238-4254 450 240179 SPRINGFIELD MEDICAL CTR/MAYO HLTH SYS 625 N JACKSON ST SPRINGFIELD MN 56087 (507) 723-4215 70 240187 HUTCHINSON COMMUNITY HOSPITAL 1095 HIGHWAY 15 SOUTH HUTCHINSON MN 55350 (612) 587-2148 420 240196 PHILLIPHS EYE INSTITUTE 2215 PARK AVENUE SOUTH MINNEAPOLIS MN 55404 (612) 347-4444 260 240205 PHS INDIAN HOSPITAL PO BOX 60 (3RD AVE W & 7TH STREET) CASS LAKE MN 56633 (218) 335-2293 100 240206 RED LAKE HOSPITAL REDLAKE MN 56671 (218) 679-3912 30 240207 FAIRVIEW RIDGES HOSPITAL 201 EAST NICOLLET BOULEVARD BURNSVILLE MN 55337 (612) 892-2000 180 240210 HEALTHEAST ST JOHN'S HOSPITAL 1575 BEAM AVENUE MAPLEWOOD MN 55109 (651) 232-7000 610 240211 LAKESIDE MEDICAL CENTER, INC 129 E SIXTH AVE PINE CITY MN 55063 (320) 629-2542 570 240213 HEALTHEAST WOODWINDS HOSPITAL 1925 WOODWINDS DRIVE WOODBURY MN 55125 (651) 232-6880 810 241300 MAHNOMEN HEALTH CENTER 414 JEFFERSON AVE W, PO BOX 396 MAHNOMEN MN 56557 (218) 935-1511 430 241301 LAKEWOOD HEALTH CENTER 600 SOUTH MAIN BAUDETTE MN 56623 (218) 634-2120 380 241302 WESTBROOK HEALTH CENTER 920 BELL AVE WESTBROOK MN 56183 (507) 274-6121 160 241303 TRACY HOSPITAL 251 FIFTH ST E TRACY MN 56175 (507) 629-3200 410 241304 WHEATON COMMUNITY HOSPITAL 401 12TH STREET NORTH WHEATON MN 56296 (320) 563-8226 770 241305 RIVERWOOD HEALTHCARE CENTER 301 MINNESOTA AVE S AITKIN MN 56431 (218) 927-2121 0 241306 RENVILLE COUNTY HOSPITAL 611 E FAIRVIEW OLIVIA MN 56277 (320) 523-1261 640 241307 ZUMBROTA HOSPITAL 383 W FIFTH ST ZUMBROTA MN 55992 (507) 732-5131 240 241308 LAKE VIEW MEMORIAL HOSPITAL 325 ELEVENTH AVE TWO HARBORS MN 55616 (218) 834-7300 370 241309 PINE MEDICAL CENTER 109 COURT AVE S SANDSTONE MN 55072 (320) 245-2212 570 241310 MINNEWASKA DISTRICT HOSPITAL 610 W 6TH ST STARBUCK MN 56381 (320) 239-2201 600 241311 SIBLEY MEDICAL CENTER 601 W CHANDLER ARLINGTON MN 55307 (507) 964-2271 710 241312 COOK HOSPITAL 10 SE FIFTH ST COOK MN 55723 (218) 666-5945 680 241313 BRIDGES MEDICAL SERVICES 201 9TH STREET WEST ADA MN 56510 (218) 784-5000 530 241314 JOHNSON MEMORIAL HOSPITAL AND HOME 1282 WALNUT STREET DAWSON MN 56232 (320) 769-4323 360 241315 JACKSON MEDICAL CENTER 1430 NORTH HIGHWAY JACKSON MN 56143 (507) 847-2420 310 241316 NORTHERN ITASCA HOSPITAL DISTRICT PO BOX 258 BIGFORK MN 56628 (218) 743-3177 300 241317 COOK COUNTY NORTH SHORE HOSPITAL PO BOX 10 GRAND MARAIS MN 55604 (218) 387-3040 150 241318 ELY BLOOMENSON COMMUNITY HOSPITAL 328 WEST CONAN STREET ELY MN 55731 (218) 365-3271 680 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 71 Provider ID Hospital Name Address City State ZIP Telephone County 241319 MURRAY COUNTY MEMORIAL HOSPITAL 2042 JUNIPER AVENUE SLAYTON MN 56172 (507) 836-6111 500 241320 RIVERVIEW HOSPITAL AND NURSING HOME 323 SOUTH MINNESOTA CROOKSTON MN 56716 (218) 281-9200 620 241321 HOLY TRINITY HOSPITAL 15 WEST SECOND STREET GRACEVILLE MN 56240 (320) 748-7223 50 241322 FALLS MEMORIAL HOSPITAL 1400 HIGHWAY 71 INTERNATIONAL FALLS MN 56649 (218) 283-5401 350 241323 MADELIA COMMUNITY HOSPITAL 121 DREW AVENUE SOUTHEAST MADELIA MN 56062 (507) 642-3255 820 241324 DIVINE PROVIDENCE HEALTH CENTER 312 EAST GEORGE STREET IVANHOE MN 56142 (507) 694-1414 400 241325 CHIPPEWA COUNTY MONTEVIDEO HOSPITAL 824 NORTH 11TH STREET MONTEVIDEO MN 56265 (320) 269-8877 110 241326 LONG PRAIRIE MEMORIAL HOSPITAL C & NC 20 NINTH STREET SOUTHEAST LONG PRAIRIE MN 56347 (320) 732-2141 760 241327 SLEEPY EYE MUNICIPAL HOSPITAL 400 FOURTH AVENUE NORTHWEST SLEEPY EYE MN 56085 (507) 794-3571 70 241328 CLEARWATER COUNTY MEMORIAL HOSPITAL 203 FOURTH STREET NORTHWEST BAGLEY MN 56621 (218) 694-6501 140 241329 LAKEWOOD HEALTH SYSTEM 401 PRAIRIE AVENUE NORTHEAST STAPLES MN 56479 (218) 894-1515 710 241330 MELROSE AREA HOSPITAL CENTRACARE 11 NORTH FIFTH AVENUE WEST MELROSE MN 56352 (320) 256-4231 160 241331 ALBANY AREA HOSPITAL 300 THIRD AVENUE ALBANY MN 56307 (320) 845-2121 720 241332 WINDOM AREA HOSPITAL 2150 HOSPITAL DRIVE, PO BOX 339 WINDOM MN 56101 (507) 831-2400 160 241333 ST JAMES HEALTH SERVICES 1207 SIXTH AVENUE SOUTH ST JAMES MN 56081 (507) 375-3261 820 241334 ST PETER COMMUNITY HOSPITAL & HCC 618 WEST BROADWAY ST PETER MN 56082 (507) 931-2200 510 241335 ST ELIZABETH HOSPITAL 1200 FIFTH GRANT BOULEVARD WEST WABASHA MN 55981 (651) 565-4531 780 241336 KITTSON MEMORIAL HOSPITAL 1010 SOUTH BIRCH HALLOCK MN 56728 (218) 843-3612 340 241337 NORTH VALLEY HEALTH CENTER 109 SOUTH MINNESOTA STREET WARREN MN 56762 (218) 745-4211 590 241338 LAKE CITY MEDICAL CENTER MAYO HEALTH 500 WEST GRANT STREET LAKE CITY MN 55041 (651) 345-3321 240 241339 HENDRICKS COMMUNITY HOSPITAL 503 E LINCOLN STREET HENDRICKS MN 56136 (507) 275-3134 400 241340 WHITE COMMUNITY HOSPITAL 5211 HIGHWAY 110 AURORA MN 55705 (218) 229-2211 0 241341 APPLETON MUNICIPAL HOSPITAL 30 SOUTH BEHL STREET APPLETON MN 56208 (651) 215-5800 750 241342 ORTONVILLE MUNICIPAL HOSPITAL 750 EASTVOLD AVENUE ORTONVILLE MN 56278 (320) 839-4127 50 241343 MUNICIPAL HOSPITAL & GRANITE MANOR 345 TENTH AVENUE GRANITE FALLS MN 56241 (320) 564-3111 860 241344 ROSEAU AREA HOSPITAL AND HOMES INC 715 DELMORE DRIVE ROSEAU MN 56751 (218) 463-2500 670 241990 CLIFTON HOUSE 301 CLIFTON AVENUE MINNEAPOLIS MN 55403 (612) 870-8111 0 242004 HEALTHEAST BETHESDA LUTHERAN HOME 559 CAPITOL BOULEVARD SAINT PAUL MN 55103 (612) 221-1750 610 243025 MINNESOTA NEUROREHABILITATION HOSPITAL 1777 HIGHWAY 18 BRAINERD MN 56401 (218) 828-2201 170 243300 GILLETTE CHILDRENS HOSPITAL 200 UNIVERSITY AVENUE EAST SAINT PAUL MN 55106 (612) 291-2848 610 243301 CHILDREN'S HEALTH CARE - SAINT PAUL 345 NORTH SMITH AVENUE SAINT PAUL MN 55102 (612) 339-0168 610 243302 CHILDREN'S HEALTH CARE - MINNEAPOLIS 2525 CHICAGO AVENUE SOUTH MINNEAPOLIS MN 55404 (612) 813-6100 260 244002 ANOKA-METRO REG TREATMENT CTR 3301 SEVENTH AVE NORTH ANOKA MN 55303 (612) 576-5500 10 244003 FERGUS FALLS REGIONAL TREATMENT CENTER NORTH UNION AVE, BOX 157 FERGUS FALLS MN 56537 (218) 739-7200 550 244004 SOUTHERN ST OPERATED SERVICES NETWORK 100 FREEMAN DRIVE SAINT PETER MN 56082 (507) 931-7115 510 244005 WILLMAR REGIONAL TREATMENT CENTER 1550 HIGHWAY 71 NORTHEAST, BOX 1128 WILLMAR MN 56201 (612) 231-5100 330 244006 NNESOS EVELETH MENTAL HEALTH SERVICES 227 MCKINLEY AVENUE EVELETH MN 55734 (218) 485-4411 80 244008 BRAINERD REGIONAL HUMAN SERVICES CTR 11800 STATE HIGHWAY 18 BRAINERD MN 56401 (218) 828-2201 170 244009 MAYO PSYCHIATRY & PSYCHOLOGY TRTMT CTR 200 FIRST ST SW ROCHESTER MN 55905 (507) 284-2511 540 250001 UNIVERSITY OF MISSISSIPPI MED CENTER 2500 N STATE ST JACKSON MS 39216 (601) 984-4100 240 250002 TISHOMINGO HEALTH SERVICES INC 1777 CURTIS DRIVE IUKA MS 38852 (662) 423-6051 700 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 72 Provider ID Hospital Name Address City State ZIP Telephone County 250004 NORTH MISSISSIPPI MEDICAL CENTER 830 S GLOSTER TUPELO MS 38801 (662) 841-3978 400 250006 BAPTIST MEMORIAL HOSPITAL UNION COUNTY 200 HWY 30 WEST NEW ALBANY MS 38652 (662) 538-7631 720 250007 BILOXI REGIONAL MEDICAL CENTER PO BOX 128/150 REYNOIR STREET BILOXI MS 39533 (228) 436-1104 230 250009 MAGNOLIA REGIONAL HEALTH CENTER 611 ALCORN DRIVE CORINTH MS 38834 (662) 293-1000 10 250010 TIPPAH COUNTY HOSPITAL 1005 CITY AVENUE NORTH RIPLEY MS 38663 (662) 837-9221 690 250012 ALLIANCE HEALTHCARE SYSTEM 1430 HIGHWAY 4 EAST HOLLY SPRINGS MS 38634 (662) 252-1212 460 250015 GRENADA LAKE MEDICAL CENTER 960 AVENT DRIVE GRENADA MS 38901 (662) 227-7000 210 250017 TRACE REGIONAL HOSP AND SWING BED HIGHWAY 8 E HOUSTON MS 38851 (662) 456-1000 80 250018 JASPER GENERAL HOSPITAL 15 SOUTH 6TH STREET BAY SPRINGS MS 39422 (601) 764-2101 300 250019 MEMORIAL HOSPITAL AT GULFPORT 4500 13TH ST-P O BOX 1810 GULFPORT MS 39502 (228) 867-4000 230 250020 WEBSTER GENERAL HOSPITAL/SWING BED 500 HIGHWAY 9 SOUTH EUPORA MS 39744 (662) 258-6221 770 250021 OKOLONA COMMUNITY HOSPITAL 512 ROCKWELL DRIVE OKOLONA MS 38860 (662) 447-3311 80 250023 PEARL RIVER COUNTY HOSPITAL 305 WEST MOODY STREET POPLARVILLE MS 39470 (601) 795-4543 540 250025 GILMORE MEMORIAL HOSPITAL 1105 EARL FRYE BLVD AMORY MS 38821 (662) 256-7111 470 250027 WINSTON MEDICAL CENTER & SWINGBED 562 EAST MAIN STREET LOUISVILLE MS 39339 (662) 773-6211 790 250030 LEAKE COUNTY MEMORIAL HOSP 310 ELLIS ST P O BOX 557 CARTHAGE MS 39051 (601) 267-4511 390 250031 RIVER REGION HEALTH SYSTEM 3311 I 20 FRONTAGE RD BOX 1031 VICKSBURG MS 39180 (601) 231-2131 740 250034 BAPTIST MEMORIAL HOSPITAL NORTH MS 2301 SOUTH LAMAR OXFORD MS 38655 (662) 232-8100 350 250035 FRANKLIN COUNTY MEMORIAL HOSPITAL HWY 84 BOX 636 MEADVILLE MS 39653 (601) 384-5801 180 250036 GEORGE COUNTY HOSPITAL P O BOX BOX 607/859 WINTER STREET LUCEDALE MS 39452 (601) 947-3161 190 250037 PRENTISS CO REGIONAL HOSP 1102 ROSE ST PRENTISS MS 39474 (601) 792-4276 320 250038 MADISON COUNTY MEDICAL CENTER HWY 16 E BOX 281 CANTON MS 39046 (601) 855-5323 440 250039 HARDY WILSON MEMORIAL HOSPITAL 233 MAGNOLIA STREET HAZLEHURST MS 39083 (601) 894-4541 140 250040 SINGING RIVER HOSPITAL SYSTEM 2809 DENNY AV PASCAGOULA MS 39581 (228) 809-5000 290 250042 NW MISSISSIPPI REGIONAL MED CENTER 1970 HOSPITAL DRIVE CLARKSDALE MS 38614 (662) 627-3211 130 250043 NESHOBA COUNTY GENERAL HOSPITAL 1001 HOLLAND AVENUE PHILADELPHIA MS 39350 (601) 663-1200 490 250044 BAPTIST MEMORIAL HOSPITAL BOONEVILLE 100 HOSPITAL DRIVE BOONEVILLE MS 38829 (662) 720-5000 580 250045 HANCOCK GENERAL HOSPITAL 149 DRINKWATER BLVD BAY SAINT LOUIS MS 39521 (228) 467-8600 220 250047 CHOCTAW COUNTY MEDICAL CENTER 148 CHERRY ST BOX 417 ACKERMAN MS 39735 (662) 285-6235 90 250048 ST DOMINIC JACKSON MEMORIAL HOSPITAL 969 LAKELAND DR JACKSON MS 39216 (601) 364-6848 240 250049 S PIKE HOSP ASSC DBA BEACHAM MEMORIAL 205 N CHERRY ST MAGNOLIA MS 39652 (601) 783-2351 560 250050 OKTIBBEHA COUNTY HOSPITAL 400 HOSPITAL ROAD STARKVILLE MS 39759 (662) 323-4320 520 250051 KILMICHAEL HOSPITAL 301 LAMAR AVENUE KILMICHAEL MS 39747 (662) 262-4311 480 250057 KING'S DAUGHTERS MEDICAL CENTER P O BOX 948/427 HIGHWAY 51 NORTH BROOKHAVEN MS 39601 (601) 833-6011 420 250058 SOUTH CENTRAL REG MED CTR 1220 JEFFERSON ST BOX 607 LAUREL MS 39440 (601) 649-4000 330 250059 MONTFORT JONES MEMORIAL HOSPITAL 220 HWY 12 WEST KOSCIUSKO MS 39090 (662) 289-4311 30 250060 JEFFERSON COUNTY HOSPITAL 809 S MAIN BOX 577 FAYETTE MS 39069 (601) 786-3401 310 250061 YALOBUSHA GENERAL HOSPITAL 630 SOUTH MAIN STREET WATER VALLEY MS 38965 (662) 473-1411 800 250065 SIMPSON GENERAL HOSPITAL 1842 SIMPSON HWY 149 MENDENHALL MS 39114 (601) 847-2221 630 250066 TYLER HOLMES MEMORIAL HOSPITAL 409 TYLER HOLMES DRIVE WINONA MS 38967 (662) 283-4114 480 250067 CLAY COUNTY MEDICAL CENTER 835 MEDICAL CENTER DR WEST POINT MS 39773 (662) 495-2300 120 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 73 Provider ID Hospital Name Address City State ZIP Telephone County 250068 CLAIBORNE COUNTY HOSPITAL 123 MCCOMB AVE PORT GIBSON MS 39150 (601) 437-5141 100 250069 RUSH FOUNDATION HOSPITAL 1314 19TH AVE MERIDIAN MS 39301 (601) 483-0011 370 250071 NORTH SUNFLOWER COUNTY HOSPITAL 840 N OAK AVE RULEVILLE MS 38771 (662) 756-2711 660 250072 CENTRAL MISSISSIPPI MEDICAL CENTER 1850 CHADWICK DR JACKSON MS 39204 (601) 376-1000 240 250077 WAYNE GENERAL HOSPITAL P O BOX 1249/950 MATTHEW DRIVE WAYNESBORO MS 39367 (601) 735-5151 760 250078 FORREST GENERAL HOSPITAL 6051 US HIGHWAY 49 HATTIESBURG MS 39404 (601) 288-7000 170 250079 SHARKEY ISAQUENA COMMUNITY HOSPITAL 108 S 4 ST ROLLING FORK MS 39159 (662) 873-4395 620 250081 RILEY MEMORIAL HOSPITAL 1102 CONSTITUTION AVENUE MERIDIAN MS 39301 (601) 693-2511 370 250082 DELTA REGIONAL MEDICAL CENTER 1400 E UNION ST GREENVILLE MS 38704 (662) 378-3783 750 250083 UNIVERSITY HOSPITAL AND CLINIC-HOLMES 239 BOWLING GREEN ROAD LEXINGTON MS 39095 (662) 834-1321 250 250084 NATCHEZ REGIONAL MEDICAL CENTER 52 SEARGENT PRENTISS DRIVE NATCHEZ MS 39120 (601) 443-2100 0 250085 MARION GENERAL HOSPITAL 1560 SUMRALL RD P O BOX 630 COLUMBIA MS 39429 (601) 736-6303 450 250089 H C WATKINS MEMORIAL HOSPITAL 605 S ARCHUSA AVE QUITMAN MS 39355 (601) 776-6925 110 250093 BOLIVAR MEDICAL CENTER 901 EAST SUNFLOWER ROAD CLEVELAND MS 38732 (662) 846-2551 50 250094 WESLEY MEDICAL CENTER 5001 W HARDY ST BOX 1331 HATTIESBURG MS 39402 (601) 268-8000 170 250095 SOUTH SUNFLOWER COUNTY HOSPITAL 121 E BAKER ST INDIANOLA MS 38751 (662) 877-5235 660 250096 RANKIN MEDICAL CENTER 350 CROSSGATES BLVD BRANDON MS 39042 (601) 825-1501 600 250097 SW MISSISSIPPI GENERAL HOSPITAL 215 MARION AV BOX 1307 MCCOMB MS 39649 (601) 249-5500 560 250098 HUMPHREYS COUNTY MEMORIAL HOSPITAL 500 CCC ROAD BELZONI MS 39038 (662) 247-3831 260 250099 GREENWOOD LEFLORE HOSPITAL 1401 RIVER RD DRAWER 1410 GREENWOOD MS 38930 (662) 459-7000 410 250100 BAPTIST MEM HOSP/GOLDEN TRIANGLE INC 2520 5TH ST N COLUMBUS MS 39701 (662) 244-1500 430 250101 UNIVERSITY HOSPITAL - DURANT,THE 713 NORTHWEST AVENUE DURANT MS 39063 (662) 653-3081 250 250102 MISSISSIPPI BAPTIST MEDICAL CENTER 1225 N STATE ST JACKSON MS 39202 (601) 968-1000 240 250104 JEFF ANDERSON REGIONAL MED CENTER 2124 14 ST MERIDIAN MS 39301 (601) 553-6000 370 250105 COVINGTON COUNTY HOSPITAL SIXTH & HOLLY STREETS COLLINS MS 39428 (601) 765-6711 150 250107 WALTHALL COUNTY GENERAL HOSPITAL 100 HOSPITAL DR TYLERTOWN MS 39667 (601) 876-2122 730 250112 HILLCREST HOSPITAL 140 BURKE-CALHOUN CITY ROAD CALHOUN CITY MS 38916 (662) 628-6611 60 250117 LUCIUS OLEN CROSBY MEMORIAL HOSPITAL 801 GOODYEAR BLVD PICAYUNE MS 39466 (601) 798-4711 540 250119 KINGS DAUGHTERS HOSPITAL SWING BED 823 GRAND AVENUE YAZOO CITY MS 39194 (662) 746-2261 810 250120 KINGS DAUGHTERS HOSPITAL 300 SOUTH WASHINGTON AVENUE GREENVILLE MS 38701 (662) 378-2020 750 250122 NATCHEZ COMMUNITY HOSPITAL/SWING BED 129 JEFFERSON DAVIS BLVD BOX 1203 NATCHEZ MS 39120 (601) 445-6205 0 250123 COLUMBIA GARDEN PARK HOSPITAL 1520 BROAD AVE GULFPORT MS 39501 (601) 864-4210 230 250124 MAGEE GENERAL HOSPITAL 300 SE 3RD ST MAGEE MS 39111 (601) 849-5070 630 250125 GULF COAST MEDICAL CENTER 180 DEBUYS ROAD BILOXI MS 39531 (228) 388-6711 230 250126 NORTH OAK REGIONAL MEDICAL CENTER 401 GETWELL DR SENATOBIA MS 38668 (662) 562-3100 680 250127 CHOCTAW HEALTH CENTER ROUTE 7 BOX R50 PHILADELPHIA MS 39350 (601) 656-2211 490 250128 TRI LAKES SENIOR CENTER 155 KEATING ROAD BATESVILLE MS 38606 (601) 563-0155 530 250131 QUITMAN COUNTY HOSPITAL & NH 340 GETWELL DR BOX 330 MARKS MS 38646 (662) 326-8031 590 250134 WHITFIELD MEDICAL SURGICAL HOSPITAL BLDG 60 OAK CIRCLE WHITFIELD MS 39193 (601) 351-8023 600 250136 WOMAN'S HOSPITAL AT RIVER OAKS 1026 NORTH FLOWOOD DRIVE FLOWOOD MS 39208 (601) 936-1000 240 250138 RIVER OAKS HOSPITAL 1030 RIVER OAKS BLVD JACKSON MS 39208 (601) 936-2390 240 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 74 Provider ID Hospital Name Address City State ZIP Telephone County 250141 BAPTIST HOSPITAL DESOTO 7601 SOUTHCREST DR SOUTHAVEN MS 38671 (662) 349-4000 160 250146 SCOTT REGIONAL HOSPITAL 317 HIGHWAY 13 SOUTH P O BOX 259 MORTON MS 39117 (601) 732-6301 610 250149 NEWTON REGIONAL HOSPITAL 208 WOUTH MAIN STREET NEWTON MS 39345 (601) 683-2031 500 250151 ALLIANCE HEALTH CENTER 5000 HIGHWAY 39 NORTH MERIDIAN MS 39303 (601) 483-6211 370 250152 MISSISSIPPI METHODIST REHAB CTR 1350 E WOODROW WILSON DR JACKSON MS 39216 (601) 981-2611 240 250153 SELECT SPECIALTY HOSP JACKSON INC 1850 CHADRICK DRIVE 5TH FLOOR JACKSON MS 39204 (601) 376-1005 240 251300 SE LACKEY CAH AND SWING-BED 330 N BROAD STREET FOREST MS 39074 (601) 469-4151 610 251302 PIONEER COMMUNITY HOSPITAL OF ABERDEEN 400 S CHESTNUT STREET ABERDEEN MS 39730 (662) 369-2455 470 251303 STONE COUNTY HOSPITAL 1434 EAST CENTTRAL AVENUE WIGGINS MS 39577 (601) 928-6600 650 251304 TALLAHATCHIE CRITICAL ACCESS HOSPITAL 202 MARKET ST BOX F CHARLESTON MS 38921 (662) 647-5535 670 251305 LAWRENCE COUNTY HOSPITAL CAH 1065 EAST BROAD ST MONTICELLO MS 39654 (601) 587-4051 380 251306 PERRY COUNTY GENERAL HOSP 206 BAY ST RICHTON MS 39476 (601) 788-6316 550 251307 NOXUBEE GENERAL CRITICAL ACCESS HOSP 606 NORTH JEFFERSON STREET MACON MS 39341 (662) 726-4231 510 251308 PONTOTOC HEALTH SERVICE CAH 176 SOUTH MAIN STREET PONTOTOC MS 38863 (662) 489-5510 570 251309 FIELD MEMORIAL COMMUNITY HOSPITAL 270 W MAIN ST PO BOX 639 CENTREVILLE MS 39631 (601) 645-5221 780 252003 RESTORATIVE CARE HOSPITAL,THE 1225 NORTH STATE ST JACKSON MS 39202 (601) 968-5130 240 252004 SPECIALITY HOSPITAL OF MERIDIAN,THE 1314 19TH AVENUE MERIDIAN MS 39301 (601) 703-4274 370 252005 SELECT SPECIALTY HOSPITAL-BILOXI 648 BEACH BOULEVARD BILOXI MS 39530 (228) 374-7474 230 254005 PARKWOOD BEHAVIORAL HEALTH SYSTEM 8135 GOODMAN ROAD OLIVE BRANCH MS 38654 (662) 895-4900 160 254007 BRENTWOOD BEHAVIORAL HEALTHCARE 3531 EAST LAKELAND DRIVE JACKSON MS 39208 (800) 954-8438 600 254008 SOUTH MISSISSIPPI STATE HOSPITAL 823 HIGHWAY 589 PURVIS MS 39475 (601) 794-0100 360 254009 NORTH MISSISSIPPI STATE HOSPITAL 1937 BRIAR RIDGE RD TUPELO MS 38804 (662) 690-4200 290 260001 ST JOHNS REGIONAL MEDICAL CENTER 2727 MCCLELLAND BLVD JOPLIN MO 64804 (417) 781-2727 480 260002 SOUTH POINT HOSPITAL 2639 MIAMI ST SAINT LOUIS MO 63118 (314) 772-1456 950 260003 AURORA COMMUNITY HOSPITAL 500 PORTER ST AURORA MO 65605 (417) 678-2122 540 260004 COOPER COUNTY MEMORIAL HOSPITAL R R 1 HWY B P O BOX 88 BOONVILLE MO 65233 (816) 882-7461 260 260005 ST JOSEPH HEALTH CENTER 300 1ST CAPITOL DR SAINT CHARLES MO 63301 (314) 947-5000 910 260006 HEARTLAND REGIONAL MEDICAL CENTER 5325 FARAON STREET SAINT JOSEPH MO 64506 (816) 271-6000 100 260008 ST LOUIS CONNECTCARE 5535 DELMAR BLVD SAINT LOUIS MO 63112 (314) 361-1212 950 260009 BOTHWELL REGIONAL HEALTH CENTER 601 E 14TH ST PO BOX 1706 SEDALIA MO 65302 (660) 827-8833 790 260011 ST MARYS HEALTH CENTER 100 ST MARY'S MEDICAL PLAZA JEFFERSON CITY MO 65101 (573) 761-7000 250 260012 COX-MONETT HOSPITAL 801 LINCOLN AVE MONETT MO 65708 (417) 354-1400 40 260013 MCCUNE BROOKS HOSPITAL 627 W CENTENNIAL ST CARTHAGE MO 64836 (417) 358-8121 480 260015 TWIN RIVERS REGIONAL MEDICAL CENTER 1301 FIRST ST KENNETT MO 63857 (314) 888-4522 340 260017 PHELPS COUNTY REGIONAL MED CENTER 1000 W 10TH ST ROLLA MO 65401 (314) 364-3100 800 260018 ST FRANCIS HOSPITAL PO BOX 82, 100 WEST HWY 60 MOUNTAIN VIEW MO 65548 (417) 934-7000 450 260020 ST JOHNS MERCY MEDICAL CENTER 615 SOUTH NEW BALLAS ROAD SAINT LOUIS MO 63141 (314) 569-6000 940 260021 FOREST PARK HOSPITAL 6150 OAKLAND AVE SAINT LOUIS MO 63139 (314) 768-3000 950 260022 NORTHEAST REGIONAL HEALTH SYSTEMS JEFFERSON AND OSTEOPATHY KIRKSVILLE MO 63501 (660) 785-1000 0 260023 JEFFERSON MEMORIAL HOSPITAL HWY 61 SOUTH BOX 350 CRYSTAL CITY MO 63019 (314) 933-1000 490 260024 TEXAS COUNTY MEMORIAL HOSPITAL 1333 SAM HOUSTON BOULEVARD HOUSTON MO 65483 (417) 967-3311 989 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 75 Provider ID Hospital Name Address City State ZIP Telephone County 260025 HANNIBAL REGIONAL HOSPITAL 8503 HIGHWAY 36 WEST HANNIBAL MO 63401 (573) 248-5260 630 260027 RESEARCH MEDICAL CENTER 2316 E MEYER BLVD KANSAS CITY MO 64132 (816) 348-1236 70 260029 EXCELSIOR SPRINGS MEDICAL CENTER 1700 RAINBOW BLVD EXCELSIOR SPRINGS MO 64024 (816) 630-6081 230 260032 BARNES JEWISH HOSPITAL 216 S KINGSHIGHWAY SAINT LOUIS MO 63110 (314) 454-7000 950 260034 BATES COUNTY MEMORIAL HOSPITAL 615 W NURSERY ST BUTLER MO 64730 (816) 679-4135 60 260035 CEDAR COUNTY MEMORIAL HOSPITAL 1401 S PARK EL DORADO SPRINGS MO 64744 (417) 876-2511 190 260036 CASS MEDICAL CENTER 1800 E MECHANIC HARRISONVILLE MO 64701 (816) 884-3291 180 260040 COX MEDICAL CENTER 1432 N JEFFERSON ST SPRINGFIELD MO 65802 (417) 269-3000 380 260044 HEDRICK MEDICAL CENTER 100 CENTRAL ST CHILLICOTHE MO 64601 (660) 646-1480 580 260047 CAPITAL REGION MED CTR - MADISON P O BOX 1128 JEFFERSON CITY MO 65102 (573) 632-5000 250 260048 TRUMAN MEDICAL CENTER HOSPITAL HILL 2301 HOLMES STREET KANSAS CITY MO 64108 (816) 556-3000 470 260050 ST FRANCIS HOSPITAL 2016 SOUTH MAIN ST MARYVILLE MO 64468 (816) 562-2600 730 260052 ST JOHNS MERCY HOSPITAL 200 MADISON AVE WASHINGTON MO 63090 (636) 239-8000 350 260053 FREEMAN NEOSHO HOSPITAL 113 W HICKORY NEOSHO MO 64850 (417) 451-1234 720 260057 CAMERON REGIONAL MEDICAL 1600 E EVERGREEN CAMERON MO 64429 (816) 632-2101 240 260059 BREECH REGIONAL MEDICAL CENTER 100 HOSPITAL DRIVE LEBANON MO 65536 (417) 533-6100 520 260061 NEVADA REGIONAL MEDICAL CENTER 800 SOUTH ASH NEVADA MO 64772 (417) 667-3355 990 260062 ST LUKES NORTHLAND HOSPITAL 601 SOUTH 169 HIGHWAY SMITHVILLE MO 64089 (816) 532-3700 230 260063 LAFAYETTE REGIONAL HEALTH CENTER 1500 STATE STREET LEXINGTON MO 64067 (660) 259-2203 530 260064 AUDRAIN MEDICAL CENTER 620 E MONROE MEXICO MO 65265 (573) 582-5000 30 260065 ST JOHNS REGIONAL HEALTH CENTER 1235 E CHEROKEE SPRINGFIELD MO 65804 (417) 885-2000 380 260067 CARROLL COUNTY MEMORIAL HOSPITAL 1502 N JEFFERSON CARROLLTON MO 64633 (816) 542-1695 160 260068 BOONE HOSPITAL CENTER 1600 E BROADWAY COLUMBIA MO 65201 (573) 815-8000 90 260070 PEMISCOT MEMORIAL HOSPITAL HWY 61 AND REED, PO BOX 489 HAYTI MO 63851 (314) 359-1372 770 260073 BARTON COUNTY MEMORIAL HOSPITAL SECOND AND GULF ST LAMAR MO 64759 (417) 682-6081 50 260074 MOBERLY REGIONAL MEDICAL CENTER 1515 UNION AVE MOBERLY MO 65270 (660) 263-8400 870 260077 ST ANTHONYS MEDICAL CENTER 10010 KENNERLY ROAD SAINT LOUIS MO 63128 (314) 525-1000 940 260078 OZARKS MEDICAL CENTER 1100 KENTUCKY AVENUE, PO BOX 1100 WEST PLAINS MO 65775 (417) 256-9111 450 260080 RIPLEY COUNTY MEMORIAL HOSPITAL GRAND AND PLUM STREET DONIPHAN MO 63935 (314) 996-2141 900 260081 SSM ST JOSEPH HOSPITAL OF KIRKWOOD 525 COUCH AVE KIRKWOOD MO 63122 (314) 966-1500 940 260085 ST JOSEPH HEALTH CENTER 1000 CARONDELET DR KANSAS CITY MO 64114 (816) 942-4400 470 260086 GENTRY COUNTY MEMORIAL HOSPITAL COLLEGE & CLARK STS ALBANY MO 64402 (816) 726-3941 370 260091 ST MARYS HEALTH CENTER 6420 CLAYTON RD RICHMOND HEIGHTS MO 63117 (314) 768-8396 940 260094 SKAGGS COMMUNITY HEALTH CENTER PO BOX 650 BUS HWY 65 & SKAGGS RD BRANSON MO 65616 (417) 335-7000 988 260095 INDEPENDENCE REG HEALTH CTR 1509 W TRUMAN RD INDEPENDENCE MO 64050 (816) 836-8100 470 260096 NORTH KANSAS CITY HOSPITAL 2800 CLAY EDWARDS DRIVE NORTH KANSAS CITY MO 64116 (816) 691-2000 230 260097 WESTERN MISSOURI MEDICAL CENTER 403 BURKARTH ROAD WARRENSBURG MO 64093 (660) 747-2500 500 260102 TRUMAN MEDICAL CENTER LAKEWOOD 7900 LEE'S SUMMIT RD KANSAS CITY MO 64139 (816) 373-4415 470 260104 DEPAUL HEALTH CENTER 12303 DEPAUL DRIVE BRIDGETON MO 63044 (314) 344-7275 940 260105 ST LOUIS UNIVERSITY HOSPITAL 3635 VISTA AT GRAND BLVD BOX 15250 SAINT LOUIS MO 63111 (314) 577-8008 950 260107 BAPTIST LUTHERAN MEDICAL CENTER 6601 ROCKHILL RD KANSAS CITY MO 64131 (816) 276-7000 470 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 76 Provider ID Hospital Name Address City State ZIP Telephone County 260108 MISSOURI BAPTIST MEDICAL CENTER 3015 N BALLAS RD SAINT LOUIS MO 63131 (314) 996-5200 940 260110 SOUTHEAST MISSOURI HOSPITAL 1701 LACEY ST CAPE GIRARDEAU MO 63701 (573) 334-4822 150 260113 MISSOURI DELTA MEDICAL CENTER 1008 NORTH MAIN ST SIKESTON MO 63801 (573) 471-1600 982 260115 MISSOURI BAPTIST HOSPITAL SULLIVAN 751 SAPPINGTON BRIDGE RD SULLIVAN MO 63080 (573) 468-4816 350 260116 MINERAL AREA REG MEDICAL CENTER 1212 WEBER RD FARMINGTON MO 63640 (573) 756-4581 930 260119 THREE RIVERS HEALTHCARE-SOUTH CAMPUS 621 PINE BOULEVARD POPLAR BLUFF MO 63901 (573) 686-4111 110 260122 RAY COUNTY MEMORIAL HOSPITAL RT 4 BOX 45 RICHMOND MO 64085 (816) 776-5432 880 260123 SOUTH BARRY COUNTY MEMORIAL 87 GRAVEL ST CASSVILLE MO 65625 (417) 847-4115 40 260127 PIKE COUNTY MEMORIAL HOSPITAL 2305 W GEORGIA LOUISIANA MO 63353 (573) 754-5531 810 260134 LINCOLN COUNTY MEDICAL CENTER 1000 E CHERRY TROY MO 63379 (636) 528-8551 560 260137 FREEMAN HEALTH SYSTEM - FREEMAN WEST 1102 WEST 32ND STREET JOPLIN MO 64804 (417) 347-1111 480 260138 ST LUKES HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 (816) 932-3800 470 260141 UNIV OF MISSOURI HOSPITAL & CLINICS 807 STADIUM RD COLUMBIA MO 65201 (314) 882-4141 90 260142 JOHN FITZGIBBON MEMORIAL HOSPITAL 2305 S 65 HIGHWAY MARSHALL MO 65340 (660) 886-7431 970 260147 SAC-OSAGE HOSPITAL P O BOX 426 OSCEOLA MO 64776 (417) 646-8181 911 260158 HERMANN AREA DISTRICT HOSPITAL P O BOX 470 HERMANN MO 65041 (573) 486-2191 360 260159 CHRISTIAN HOSPITAL NORTHWEST 1225 GRAHAM ROAD FLORISSANT MO 63031 (314) 952-6000 940 260160 MISSOURI SOUTHERN HEALTHCARE 1200 NORTH ONE MILE ROAD BOX 279 DEXTER MO 63841 (314) 624-5566 985 260162 BARNES-JEWISH WEST COUNTY HOSPITAL 12634 OLIVE BOULEVARD SAINT LOUIS MO 63141 (314) 996-8400 940 260163 PARKLAND HEALTH CENTER 1101 W LIBERTY FARMINGTON MO 63640 (573) 756-6451 930 260164 STE GENEVIEVE COUNTY MEM HOSPITAL HIGHWAY 61 & 32 SAINTE GENEVIEVE MO 63670 (573) 883-2751 960 260166 MEDICAL CENTER OF INDEPENDENCE 17203 E 23RD ST INDEPENDENCE MO 64057 (816) 478-5000 470 260172 SALEM MEMORIAL DISTRICT HOSPITAL HIGHWAY 72 NORTH BOX 774 SALEM MO 65560 (573) 729-6626 320 260175 GOLDEN VALLEY MEMORIAL 1600 NORTH SECOND CLINTON MO 64735 (660) 885-5511 410 260176 DES PERES HOSPITAL 2345 DOUGHERTY FERRY ROAD SAINT LOUIS MO 63131 (314) 821-5850 940 260177 LIBERTY HOSPITAL 2525 GLENN HENDREN DR LIBERTY MO 64068 (816) 781-7200 230 260178 COLUMBIA REGIONAL HOSPITAL 404 KEENE ST COLUMBIA MO 65201 (573) 875-9000 90 260179 ST LUKES HOSPITAL 232 S WOODS MILL RD CHESTERFIELD MO 63017 (314) 434-1500 940 260180 CHRISTIAN HOSPITAL NORTHEAST 11133 DUNN ROAD SAINT LOUIS MO 63136 (314) 653-5000 940 260183 ST FRANCIS MEDICAL CENTER 211 ST FRANCIS DR CAPE GIRARDEAU MO 63703 (573) 331-3000 260 260186 LAKE REGIONAL HEALTH SYSTEM 54 HOSPITAL DRIVE OSAGE BEACH MO 65065 (573) 348-8000 140 260190 LEES SUMMIT HOSPITAL 530 NW MURRAY RD LEES SUMMIT MO 64081 (816) 969-6000 470 260191 BARNES-JEWISH ST PETERS HOSPITAL 10 HOSPITAL DR SAINT PETERS MO 63376 (636) 916-9000 910 260193 ST MARYS HOSPITAL OF BLUE SPRINGS 201 WEST R D MIZE RD BLUE SPRINGS MO 64015 (816) 228-5900 470 260195 CITIZENS MEMORIAL HOSPITAL 1500 N OAKLAND BOX 67 BOLIVAR MO 65613 (417) 326-6000 821 260198 CROSSROADS REGIONAL HOSPITAL 500 MEDICAL DRIVE PO BOX 711 WENTZVILLE MO 63385 (314) 327-1000 910 260200 ST JOSEPH HOSPITAL WEST 100 MEDICAL PLAZA LAKE SAINT LOUIS MO 63367 (636) 625-5200 910 260207 DOCTOR'S HOSPISTAL OF SPRINGFIELD 2828 NORTH NATIONAL SPRINGFIELD MO 65803 (417) 837-4000 380 260208 SELECT SPECIALTY HOSPITAL 6150 OAKLAND AVENUE 5TH FLOOR SAINT LOUIS MO 63139 (314) 725-0112 940 260209 CALLAWAY COMMUNITY HOSPITAL 10 SOUTH HOSPITAL DRIVE FULTON MO 65251 (573) 642-3376 130 260210 ST ALEXIOUS HOSPITAL 3933 S BROADWAY SAINT LOUIS MO 63118 (314) 865-3333 940 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 77 Provider ID Hospital Name Address City State ZIP Telephone County 260211 CANCER INSTITUTE,THE 2316 E MEYER BLVD KANSAS CITY MO 64132 (816) 932-5734 470 261301 ELLETT MEMORIAL HOSPITAL 610 NORTH OHIO APPLETON CITY MO 64724 (660) 476-2111 911 261302 MADISON MEDICAL CENTER 100 SOUTH WOOD AT WEST COLLEGE PO B FREDERICKTOWN MO 63645 (573) 783-3341 601 261303 COMMUNITY HOSPITAL ASSOCIATION, INC HWY 59 PO BOX 107 FAIRFAX MO 64446 (660) 686-2211 20 261304 REYNOLDS CO GENERAL MEM HOSPITAL HIGHWAY 21 SOUTH, PO BOX 520 ELLINGTON MO 63638 (573) 663-2511 881 261305 PUTNAM COUNTY MEMORIAL HOSPITAL 1926 OAK STREET, PO BOX 389 UNIONVILLE MO 63565 (816) 947-2411 850 261306 SULLIVAN COUNTY MEMORIAL HOSPITAL 630 WEST THIRD STREET MILAN MO 63556 (660) 265-4212 987 261307 PERSHING MEMORIAL HOSPITAL 130 EAST LOCKLING BROOKFIELD MO 64628 (660) 258-2222 570 261308 WASHINGTON COUNTY MEMORIAL HOSPITAL 300 HEALTH WAY POTOSI MO 63664 (573) 438-5451 992 261309 WRIGHT MEMORIAL HOSPITAL 701 EAST FIRST STREET TRENTON MO 64683 (660) 359-5621 390 261310 SCOTLAND COUNTY MEMORIAL HOSPITAL RR1 BOX 53 MEMPHIS MO 63555 (660) 465-8511 981 261311 PERRY COUNTY MEMORIAL HOSPITAL 434 NORTH WEST STREET PERRYVILLE MO 63775 (573) 547-2536 780 261312 HARRISON COUNTY COMMUNITY HOSPITAL PO BOX 428 2600 MILLER STREET BETHANY MO 64424 (660) 425-2211 400 261313 MACON CO SAMARITAN MEMORIAL HOSPITAL 1205 NORTH MISSOURI MACON MO 63552 (660) 385-3151 600 262001 MISSOURI REHABILITATION CTR 600 N MAIN MOUNT VERNON MO 65712 (417) 466-3711 540 262010 KINDRED HOSPITAL - ST LOUIS 4930 LINDELL BOULEVARD SAINT LOUIS MO 63108 (314) 361-8700 950 262011 KINDRED HOSPITAL - KANSAS CITY 8701 TROOST AVENUE KANSAS CITY MO 64131 (816) 995-2000 470 262012 ALL SAINTS SPECIAL CARE HOSPITAL 12303 DEPAUL DRIVE - 2ND FLOOR SOUTH BRIDGETON MO 63044 (314) 344-7838 940 263025 SSM REHAB INSTITUTE 9101 S BROADWAY SAINT LOUIS MO 63125 (314) 631-7800 940 263027 RUSK REHABILITATION CENTER LLC 315 BUSINESS LOOP 70 WEST COLUMBIA MO 65203 (573) 817-2703 90 263028 REHABILITATION INSTITUTE OF ST LOUIS 4455 DUNCAN AVENUE SAINT LOUIS MO 63108 (314) 100-1000 940 263301 ST LOUIS CHILDRENS HOSPITAL ONE CHILDRENS PLACE SAINT LOUIS MO 63110 (314) 454-6000 950 263302 CHILDRENS MERCY HOSPITAL 2401 GILLHAM ROAD KANSAS CITY MO 64108 (816) 234-3000 470 263303 RANKEN JORDAN A PEDIATRIC REHAB 10621 LADUE ROAD CREVE COEUR MO 63141 (314) 993-1207 940 264004 FULTON STATE HOSP 600 EAST 5TH STREET FULTON MO 65251 (573) 592-4100 130 264005 SOUTHEAST MISSOURI MENTAL HLTH CTR 1010 WEST COLUMBIA STREET FARMINGTON MO 63640 (573) 218-6792 930 264007 NORTHWEST MO PSYCHIATRIC REHAB CTR 3505 FREDERICK AVENUE SAINT JOSEPH MO 64502 (816) 387-2300 400 264008 WESTERN MISSOURI MHC 600 E 22ND ST KANSAS CITY MO 64108 (816) 471-3000 470 264010 ST LOUIS STATE HOSP 5400 ARSENAL ST SAINT LOUIS MO 63139 (314) 644-8000 950 264011 HEART OF MISSOURI MENTAL HEALTH THREE HOSPITAL DRIVE COLUMBIA MO 65201 (573) 449-2511 90 264012 SPIRIT OF ST LOUIS HOSPITAL 5931 HWY 94 S SAINT CHARLES MO 63304 (636) 441-7300 910 264013 HEARTLAND BEHAVORIAL HEALTH SERVICES 1500 WEST ASHLAND NEVADA MO 64772 (417) 667-2666 990 264016 RESEARCH PSYCHIATRIC CTR 2323 E 63RD ST KANSAS CITY MO 64130 (816) 444-8161 470 264017 TWO RIVERS PSYCHIATRIC HOSPITAL 5121 RAYOWN ROAD KANSAS CITY MO 64133 (816) 356-5688 470 264018 CRITTENTON BEHAVIORAL HEALTH CENTER 10918 ELM AVENUE KANSAS CITY MO 64134 (816) 765-6600 470 264020 ROYAL OAKS HOSPITAL 307 N MAIN WINDSOR MO 65360 (660) 647-2182 410 264024 LAKELAND REGIONAL HOSPITAL 440 S MARKET SPRINGFIELD MO 65806 (417) 865-5581 380 264025 METROPOLITAN ST LOUIS PSYCHIATRIC CTR 5351 DELMAR BOULEVARD SAINT LOUIS MO 63112 (314) 877-0500 950 270002 HOLY ROSARY HEALTHCARE 2600 WILSON MILES CITY MT 59301 (406) 233-2600 80 270003 ST PETERS COMMUNITY HOSPITAL 2475 BROADWAY HELENA MT 59601 (406) 442-2480 240 270004 DEACONESS BILLINGS CLINIC 2800 10TH AVE NO BOX 37000 BILLINGS MT 59107 (406) 657-4688 550 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 78 Provider ID Hospital Name Address City State ZIP Telephone County 270006 BROADWATER HEALTH CENTER 110 NO OAK ST TOWNSEND MT 59644 (406) 266-3186 30 270009 COMMUNITY HOSPITAL OF ANACONDA 401 W PENNSYLVANIA AVE ANACONDA MT 59711 (406) 563-8511 110 270011 CENTRAL MONTANA MEDICAL CTR 408 WENDELL LEWISTOWN MT 59457 (406) 538-7711 130 270012 BENEFIS HEALTHCARE 1101 26TH STREET SOUTH GREAT FALLS MT 59405 (406) 455-5000 60 270014 ST PATRICK HOSPITAL CORP 500 W BROADWAY BOX 4587 MISSOULA MT 59806 (406) 543-7271 310 270017 ST JAMES HEALTHCARE 400 SOUTH CLARK ST BOX 3300 BUTTE MT 59701 (406) 723-2500 460 270019 ST LUKE COMMUNITY HOSPITAL 107 6TH AVE SW RONAN MT 59864 (406) 676-4441 230 270021 SIDNEY HEALTH CENTER PO BOX 1690 SIDNEY MT 59270 (406) 488-2100 410 270023 COMMUNITY MEDICAL CENTER INC 2827 FT MISSOULA RD MISSOULA MT 59801 (406) 728-4100 310 270026 MARIAS MEDICAL CENTER 640 PARK DR BOX P SHELBY MT 59474 (406) 434-3200 500 270027 LIBERTY COUNTY HOSPITAL HIGHWAY 223 & MONROE PO BOX 705 CHESTER MT 59522 (406) 759-5181 250 270032 NORTHERN MONTANA HOSPITAL PO BOX 1231 HAVRE MT 59501 (406) 265-2211 200 270036 DANIELS MEMORIAL HOSPITAL PO BOX 400 SCOBEY MT 59263 (406) 487-2296 90 270040 NORTH VALLEY HOSPITAL 6575 HIGHWAY 93 SOUTH WHITEFISH MT 59937 (406) 863-3500 140 270048 GLENDIVE MEDICAL CENTER 202 PROSPECT DRIVE GLENDIVE MT 59330 (406) 345-3306 100 270049 ST VINCENT HEALTHCARE 1233 N 30TH ST PO BOX 35200 BILLINGS MT 59107 (406) 237-3065 550 270050 MARCUS DALY MEMORIAL HOSPITAL 1200 WESTWOOD DR HAMILTON MT 59840 (406) 363-2211 400 270051 KALISPELL REGIONAL HOSPITAL 310 SUNNYVIEW LANE KALISPELL MT 59901 (406) 752-5111 140 270057 BOZEMAN DEACONESS HOSPITAL 915 HIGHLAND BLVD BOZEMAN MT 59715 (406) 585-1040 150 270058 SHERIDAN MEMORIAL HOSPITAL 440 WEST LAUREL AVE PLENTYWOOD MT 59254 (406) 765-1420 450 270060 TRINITY HOSPITAL 315 KNAPP STREET WOLF POINT MT 59201 (406) 653-2100 420 270073 MINERAL COMMUNITY HOSPITAL BROOKLYN & ROOSEVELT PO BOX 66 SUPERIOR MT 59872 (406) 822-4841 300 270074 PHS INDIAN HOSPITAL BROWNING MT 59417 (406) 338-7283 170 270075 PHS INDIAN HOSPITAL CROW AGENCY BIGHORN MT 59010 (406) 638-2626 510 270079 BIG HORN COUNTY MEMORIAL HOSPITAL 17 N MILES HARDIN MT 59034 (406) 665-2310 10 270081 ROUNDUP MEMORIAL HOSPITAL 1202 3RD ST WEST, PO BOX 40 ROUNDUP MT 59072 (406) 323-2301 320 270082 NORTHERN ROCKIES MEDICAL CENTER INC 802 2ND ST S E CUT BANK MT 59427 (406) 873-2251 170 270084 ST JOSEPH HOSPITAL CORP BOX 1010 SKYLINE DR POLSON MT 59860 (406) 883-5377 230 271300 POPLAR COMMUNITY HOSPITAL - CAH CORNER OF H AND COURT POPLAR MT 59255 (406) 768-3452 420 271301 FALLON MEDICAL COMPLEX CAH 202 SOUTH 4TH STREET WEST BAKER MT 59313 (406) 778-3331 120 271302 DAHL MEMORIAL HEALTHCARE ASSOC - CAH PO BOX 46 EKALAKA MT 59324 (406) 775-8730 50 271303 GRANITE COUNTY MEDICAL CENTER - CAH PO BOX 729 PHILIPSBURG MT 59858 (406) 859-3271 190 271304 MISSOURI RIVER MEDICAL CENTER - CAH 1501 ST CHARLES STREET FORT BENTON MT 59442 (406) 622-3331 70 271305 MCCONE COUNTY HEALTH CENTER - CAH 605 SULLIVAN AVENUE CIRCLE MT 59215 (406) 485-3381 270 271306 MOUNTAIN VIEW MEDICAL CENTER - CAH 16 WEST MAIN STREET PO BOX Q WHITE SULPHUR SPRINMT 59645 (406) 547-3321 290 271307 TETON MEDICAL CENTER -CAH 915 FOURTH STREET NORTHWEST CHOTEAU MT 59422 (406) 466-5763 490 271308 ROOSEVELT MEMORIAL MEDICAL CTR - CAH 8181 2ND AVENUE EAST CULBERTSON MT 59218 (406) 787-6281 420 271309 PRAIRIE COMMUNITY CAH 312 S ADAMS TERRY MT 59349 (406) 637-5511 390 271310 GARFIELD COUNTY HEALTH CENTER INC -CAH PO BOX 389 JORDAN MT 59337 (406) 557-2500 160 271311 BIG SANDY MEDICAL CENTER - CAH 3 MONTANA AVE PO BOX 530 BIG SANDY MT 59520 (406) 378-2188 70 271312 PHILLIPS COUNTY MEDICAL CENTER - CAH PO BOX 640 MALTA MT 59538 (406) 654-1100 350 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 79 Provider ID Hospital Name Address City State ZIP Telephone County 271313 PIONEER MEDICAL CENTER - CAH PO BOX 1228 BIG TIMBER MT 59011 (406) 932-4603 480 271314 POWELL COUNTY MEMORIAL HOSPITAL - CAH 1101 TEXAS AVENUE DEER LODGE MT 59722 (406) 846-2212 380 271315 PHS IHS HOSPITAL FT BELKNAP - CAH 456 GROS VENTRE AVE HARLEM MT 59526 (406) 353-3191 20 271316 FRANCES MAHON DEACONESS HOSPITAL - CAH 621 3RD STREET SOUTH GLASGOW MT 59230 (406) 228-3500 520 271317 LIVINGSTON HEALTHCARE (CAH) 504 SOUTH 13TH STREET LIVINGSTON MT 59047 (406) 222-3541 330 271318 BARRETT MEMORIAL HOSPITAL CAH 1260 ATLANTIC DILLON MT 59725 (406) 683-3000 0 271319 RUBY VALLEY HOSPITAL - CAH 220 EAST CROFOOT, BOX336 SHERIDAN MT 59749 (406) 842-5453 280 271320 ST JOHN'S LUTHERAN HOSPITAL - CAH 350 LOUISIANA AVENUE LIBBY MT 59923 (406) 293-0100 260 271321 WHEATLAND MEMORIAL HOSPITAL - CAH 530 3RD STREET SW PO BOX 287 HARLOWTON MT 59036 (406) 635-4351 530 271322 SHERIDAN MEMORIAL CAH 440 WEST LAUREL AVENUE PLENTYWOOD MT 59254 (406) 765-1420 450 271323 CLARK FORK VALLEY HOSPITAL - CAH 110 KRUGER ROAD PO BOX 768 PLAINS MT 59859 (406) 826-4800 440 271324 PONDERA MEDICAL CLINIC - CAH 805 SUNSET BOULEVARD CONRAD MT 59425 (406) 271-3211 360 271325 ST LUKE COMMUNITY HOSPITAL-CAH 107 6TH AVENUE SW RONAN MT 59864 (406) 676-4441 230 271326 BEARTOOTH HOSPITAL & HEALTH CENTER 600 WEST 21ST STREET RED LODGE MT 59068 (406) 446-2345 40 271327 ROSEBUD HEATLH CARE CENTER - CAH 383 NORTH 17TH AVENUE FORSYTH MT 59327 (406) 356-2161 430 271328 MARIAS MEDICAL CENTER 640 PRK DRIVE PO BOX 915 SHELBY MT 59474 (406) 434-3207 500 271329 MADISON VALLEY HOSPITAL CAH 217 US HIGHWAY 287, PO BOX 397 ENNIS MT 59729 (406) 682-4274 280 271330 STILLWATER COMMUNITY HOSPITAL CAH 44 WEST 4TH AVENUE NORTH COLUMBUS MT 59019 (406) 332-5116 470 271331 MINERAL COMMUNITY HOSPITAL - CAH 1208 6TH AVENUE EAST SUPERIOR MT 59872 (406) 822-4841 300 274004 SHODAIR CHILDREN'S HOSPITAL 2755 COLONIAL DR PO BOX 5539 HELENA MT 59604 (406) 444-7500 240 274086 MONTANA STATE HOSPITAL BOX 300 WARM SPRINGS MT 59756 (406) 693-7000 110 280003 BRYANLGH MEDICAL CENTER 1600 SOUTH 48TH STREET LINCOLN NE 68506 (402) 489-0200 540 280009 GOOD SAMARITAN HOSPITAL 10 E 31ST STREET P O BOX 1990 KEARNEY NE 68848 (308) 865-7907 90 280010 DOUGLAS COUNTY HEALTH CENTER 4102 WOOLWORTH AVE OMAHA NE 68105 (402) 444-7301 270 280013 NEBRASKA HEALTH SYSTEM 987400 NEBRASKA MEDICAL CENTER OMAHA NE 68198 (402) 552-2040 270 280015 MEMORIAL HEALTH CENTER 645 OSAGE STREET SIDNEY NE 69162 (308) 254-5825 160 280020 ST ELIZABETH REGIONAL MEDICAL CENTER 555 SOUTH 70TH STREET LINCOLN NE 68510 (402) 489-7181 540 280021 COMMUNITY HOSPITAL P O BOX 1328, 1301 EAST H STREET MCCOOK NE 69001 (308) 345-2650 720 280023 ST FRANCIS MEDICAL CENTER 2620 WEST FAIDLEY GRAND ISLAND NE 68803 (308) 384-4600 390 280030 ST JOSEPH HOSPITAL 601 N 30TH ST OMAHA NE 68108 (402) 449-5021 270 280032 MARY LANNING MEMORIAL HOSPITAL 715 N ST JOSEPH AVE HASTINGS NE 68901 (402) 463-4521 0 280040 NEBRASKA METHODIST HOSPITAL,THE 8303 DODGE STREET OMAHA NE 68114 (402) 390-4000 270 280047 MEMORIAL COMMUNITY HOSPITAL 810 N 22ND ST BLAIR NE 68008 (402) 426-2182 480 280054 BEATRICE COMM HOSPITAL & HLTH CENTER 1110 NORTH 10TH STREET, P O BOX 278 BEATRICE NE 68310 (402) 228-3344 330 280057 JENNIE M MELHAM MEMORIAL MED CENTER PO BOX 250, 145 MEMORIAL DRIVE BROKEN BOW NE 68822 (308) 872-6891 200 280060 ALEGENT HEALTH-BERGAN MERCY MEDICAL CE 7500 MERCY RD OMAHA NE 68124 (402) 398-6763 270 280061 REGIONAL WEST MED CENTER 4021 AVE B SCOTTSBLUFF NE 69361 (308) 635-3711 780 280065 GREAT PLAINS REGIONAL MEDICAL CENTER 601 W LEOTA ST NORTH PLATTE NE 69101 (308) 534-9310 550 280075 GORDON MEMORIAL HOSPITAL 300 EAST 8TH STREET GORDON NE 69343 (308) 282-0401 800 280077 FREMONT AREA MEDICAL CENTER 450 E 23RD ST FREMONT NE 68025 (402) 721-1610 260 280081 IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 (402) 572-2121 270 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 80 Provider ID Hospital Name Address City State ZIP Telephone County 280105 ALEGENT HEALTH - MIDLANDS COMM HOSP 11111 S 84TH ST PAPILLION NE 68046 (402) 593-3000 760 280108 PHELPS MEMORIAL HEALTH CENTER 1220 MILLER STREET HOLDREGE NE 68949 (308) 995-2211 680 280111 COLUMBUS COMMUNITY HOSPITAL P O BOX 1800, 3020 18TH ST COLUMBUS NE 68601 (402) 564-7118 700 280117 TRI-COUNTY AREA HOSPITAL DISTRICT 1201 NORTH ERIE STREET PO BOX 980 LEXINGTON NE 68850 (308) 324-5651 230 280118 BOX BUTTE GENERAL HOSPITAL 2101 BOX BUTTE AVE ALLIANCE NE 69301 (308) 762-6660 60 280119 PHS INDIAN HOSPITAL WINNEBAGO NE 68071 (402) 878-2231 860 280123 BEATRICE STATE DEVELOPMENTAL CENTER 3000 LINCOLN BLVD PO BOX 808 BEATRICE NE 68310 (402) 223-2302 330 280125 FAITH REGIONAL HEALTH SERVICES 2700 WEST NORFOLK AVE NORFOLK NE 68701 (402) 644-7205 590 281300 HARLAN COUNTY HEALTH SYSTEM 717 NORTH BROWN STREET PO BOX 836 ALMA NE 68920 (308) 928-2151 410 281301 FILLMORE COUNTY HOSPITAL 1325 H STREET, P O BOX 193 GENEVA NE 68361 (402) 759-3167 290 281302 PAWNEE COUNTY MEMORIAL HOSPITAL PO BOX 313 600 I STREET PAWNEE CITY NE 68420 (402) 852-2231 660 281303 NIOBRARA VALLEY HOSPITAL CORP PO BOX 118 LYNCH NE 68746 (402) 569-2451 70 281304 THAYER COUNTY HEALTH SERVICES 120 PARK AVENUE HEBRON NE 68370 (402) 768-6041 840 281305 KIMBALL COUNTY HOSPITAL 505 SOUTH BURG STREET KIMBALL NE 69145 (308) 235-3621 520 281306 KEARNEY COUNTY HEALTH SERVICES-HOSP 727 EAST 1ST STREET MINDEN NE 68959 (308) 832-1440 490 281307 SAUNDERS COUNTY HEALTH SERVICES PO BOX 185 805 WEST 10TH STREET WAHOO NE 68066 (402) 443-4191 770 281308 HENDERSON HEALTH CARE SERVICES PO BOX 217, 1621 FRONT STREET HENDERSON NE 68371 (402) 723-4512 920 281309 COMMUNITY MEMORIAL HOSPITAL PO BOX N, 1579 MIDLAND STREET SYRACUSE NE 68446 (402) 269-2011 650 281310 GARDEN COUNTY HOSPITAL & NURSING HOME PO BOX 320, 1100 WEST 2ND OSHKOSH NE 69154 (308) 772-3283 340 281311 FRANKLIN COUNTY MEMORIAL HOSPITAL PO BOX 315 1406 Q STREET FRANKLIN NE 68939 (308) 425-6221 300 281312 GENOA COMMUNITY HOSPITAL PO BOX 310, 606/706 EWING AVENUE GENOA NE 68640 (402) 993-2283 620 281313 GOTHENBURG MEMORIAL HOSPITAL PO BOX 469 910 20TH STREET GOTHENBURG NE 69138 (308) 537-3661 230 281314 ANNIE JEFFREY MEMORIAL CO HEALTH CTR PO BOX 428 531 BEEBE STREET OSCEOLA NE 68651 (402) 747-2031 710 281315 BRODSTONE MEMORIAL NUCKOLLS CO HOSP PO BOX 187 520 EAST 10TH STREET SUPERIOR NE 68978 (402) 879-3281 640 281316 WEBSTER SOUNTY COMMUNITY HOSPITAL PO BOX 465 6TH AND FRANKLIN STREET RED CLOUD NE 68970 (402) 746-2291 900 281317 TILDEN COMMUNITY HOSPITAL PO BOX 340 308 WEST 2ND & PINE TILDEN NE 68781 (402) 368-5343 10 281318 MORRILL COUNTY COMMUNITY HOSPITAL 1313 S STREET BRIDGEPORT NE 69336 (308) 262-1616 610 281319 JEFFERSON COMMUNITY HEALTH CENTER PO BOX 277 2200 H STREET FAIRBURY NE 68352 (402) 729-3351 470 281320 MEMORIAL HOSPITAL 1423 SEVENTH STREET AURORA NE 68818 (402) 694-3171 440 281321 OAKLAND MEMORIAL HOSPITAL 601 EAST SECOND STREET OAKLAND NE 68045 (402) 685-5601 100 281322 ST FRANCIS MEMORIAL HOSPITAL 430 NORTH MONITOR STREET WEST POINT NE 68788 (402) 372-2404 190 281323 ALEGENT HEALTH MEMORIAL HOSPITAL 104 WEST 17TH STREET SCHUYLER NE 68661 (402) 352-2441 180 281324 NEMAHA COUNTY HOSPITAL 2022 13TH STREET AUBURN NE 68305 (402) 274-4366 630 281325 BROWN COUNTY HOSPITAL 945 EAST ZERO STREET AINSWORTH NE 69210 (402) 387-2800 80 281326 ANTELOPE MEMORIAL HOSPITAL PO BOX 229 102 WEST 9TH STREET NELIGH NE 68756 (402) 887-4151 530 281327 COZAD COMMUNITY HOSPITAL PO BOX 108, 300 EAST 12TH STREET COZAD NE 69130 (308) 784-2261 230 281328 LITZENBERG MEMORIAL COUNTY HOSPITAL 1715 26TH STREET CENTRAL CITY NE 68826 (308) 946-3015 600 281329 AVERA ST ANTHONYS HOSPITAL 2ND AND ADAMS STREETS O' NEILL NE 68763 (402) 336-2611 440 281330 WARREN MEMORIAL HOSPITAL 905 SECOND STREET FRIEND NE 68359 (402) 947-2541 750 281331 CREIGHTON AREA HEALTH SERVICES PO BOX 186 /1503 MAIN STREET CREIGHTON NE 68729 (402) 358-3322 530 281332 BUTLER COUNTY HEALTH CARE CENTER 372 SOUTH 9TH STREET DAVID CITY NE 68632 (402) 367-3115 110 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 81 Provider ID Hospital Name Address City State ZIP Telephone County 281333 ROCK COUNTY HOSPITAL HC 75 BOX 300 BASSETT NE 68714 (402) 684-3366 740 281334 BOONE COUNTY HEALTH CENTER PO BOX 151 723 WEST FAIRVIEW STREET ALBION NE 68620 (402) 395-2191 50 281335 CALLAWAY DISTRICT HOSPITAL PO BOX 100 211 KIMBALL STREET CALLAWAY NE 68825 (308) 836-2228 200 281336 YORK GENERAL HOSPITAL 2222 LINCOLN AVENUE YORK NE 68467 (402) 362-6671 920 281338 HOWARD COUNTY COMMUNITY HOSPITAL PO BOX 406 1102 KENDALL STREET SAINT PAUL NE 68873 (308) 754-4421 460 281339 MEMORIAL HOSPITAL CAH 300 NORTH COLUMBIA AVENUE SEWARD NE 68434 (402) 643-2971 790 281340 DUNDY COUNTY HOSPITAL 1313 N CHEYENNE ST PO BOX 626 BENKELMAN NE 69021 (308) 423-2204 280 281341 CHADRON COMMUNITY HOSPITAL HLTH SRV 821 MOREHEAD STREET CHADRON NE 69337 (308) 432-5586 220 281342 ST MARYS HOSPITAL 1314 3RD AVENUE NEBRASKA CITY NE 68410 (402) 873-3321 650 281343 WEST HOLT MEMORIAL HOSPITAL 406 WEST NEELY STREET RR1 BOX 200 ATKINSON NE 68713 (402) 925-2811 440 281344 CHERRY COUNTY HOSPITAL 510 NORTH GREEN STREET VALENTINE NE 69201 (402) 376-2525 150 281345 PROVIDENCE MEDICAL CENTER 1200 PROVIDENCE ROAD WAYNE NE 68787 (402) 375-3800 890 281346 PLAINVIEW PUBLIC HOSPITAL PO BOX 489 704 NORTH 3RD PLAINVIEW NE 68769 (402) 582-4245 690 281347 OSMOND GENERAL HOSPITAL PO BOX 429 5TH AND MAPLE OSMOND NE 68765 (402) 748-3393 690 281348 TRI VALLEY HEALTH SYSTEM PO BOX 488 WEST HWY6 AND 34 CAMBRIDGE NE 69022 (308) 697-3329 320 281349 PENDER COMMUNITY HOSPITAL PO BOX 100 603 EARL STREET PENDER NE 68047 (402) 385-3083 860 281350 JOHNSON COUNTY HOSPITAL 202 HIGH STREET TECUMSEH NE 68450 (402) 335-3361 480 281351 CHASE COUNTY COMMUNITY HOSPITAL PO BOX 819 600 WEST 12TH STREET IMPERIAL NE 69033 (308) 882-7111 140 281352 COMMUNITY MEDICAL CENTER PO BOX 399 2307 BARADA STREET FALLS CITY NE 68355 (402) 245-2428 730 281353 VALLEY COUNTY HOSPITAL 217 WESTRIDGE DRIVE ORD NE 68862 (308) 728-3211 870 281354 CRETE AREA MEDICAL CENTER P O BOX 220 1540 GROVE AVENUE CRETE NE 68333 (402) 826-6800 750 281355 OGALLALA COMMUNITY HOSPITAL 2601 NORTH SPRUCE STREET OGALLALA NE 69153 (308) 284-4011 490 281356 PERKINS COUNTY HEALTH SERVICES 900 LINCOLN AVENUE GRANT NE 69140 (308) 352-7200 670 282000 MADONNA REHABILITATION LTC HOSPITAL 5401 SOUTH STREET LINCOLN NE 68506 (402) 489-7102 540 282001 SELECT SPECIALTY HOSPITAL - OMAHA 11111 S 84TH STREET PAPILLION NE 68046 (402) 898-2700 760 283025 MADONNA REHABILITATION HOSPITAL 5401 SOUTH STREET LINCOLN NE 68506 (402) 489-7102 540 283300 BOYS TOWN NATIONAL RESEARCH HOSPITAL 555 NORTH 30TH STREET OMAHA NE 68131 (402) 498-6362 270 283301 CHILDREN'S MEM HOSP 8200 DODGE ST OMAHA NE 68114 (402) 390-5400 270 284002 HASTINGS REGIONAL CENTER PO BOX 579, 4200 W 2ND HASTINGS NE 68902 (402) 462-1971 0 284003 LINCOLN REGIONAL CENTER PO BOX 94949 LINCOLN NE 68509 (402) 479-5470 540 284004 NORFOLK REGIONAL CENTER 1700 NORTH VICTORY RD P O BOX 1209 NORFOLK NE 68701 (402) 370-3400 590 284007 RICHARD H YOUNG HOSPITAL P O BOX 1750, 1755 PRAIRIE VIEW PL KEARNEY NE 68847 (308) 236-2000 90 284008 RICHARD YOUNG CENTER 515 SOUTH 26TH STREET OMAHA NE 68105 (402) 354-6687 270 284009 DOUGLAS COUNTY HEALTH CENTER 4102 WOOLWORTH AVENUE OMAHA NE 68105 (402) 444-7301 270 290001 WASHOE MEDICAL CENTER 77 PRINGLE WAY RENO NV 89502 (775) 982-4000 150 290002 SOUTH LYON MEDICAL CENTER SURPRISE AT WHITACRE AVE YERINGTON NV 89447 (775) 463-2301 90 290003 SUNRISE HOSPITAL & MEDICAL CENTER 3186 S MARYLAND PKWY LAS VEGAS NV 89109 (702) 731-8000 10 290005 LAKE MEAD HOSPITAL MEDICAL CENTER 1409 EAST LAKE MEAD BLVD NORTH LAS VEGAS NV 89030 (702) 649-7711 10 290006 CHURCHILL COMMUNITY HOSPITAL 801 EAST WILLIAMS AVENUE FALLON NV 89406 (775) 423-3151 0 290007 U M C OF SOUTHERN NEVADA 1800 WEST CHARLESTON BLVD LAS VEGAS NV 89102 (702) 383-2000 10 290008 NORTHEASTERN NV REGIONAL HOSPITAL 2001 ERRECART BLVD ELKO NV 89801 (775) 738-5151 30 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 82 Provider ID Hospital Name Address City State ZIP Telephone County 290009 ST MARYS REGIONAL MEDICAL CENTER 235 W 6TH ST RENO NV 89520 (775) 770-3000 150 290010 BOULDER CITY HOSPITAL 901 ADAMS BOULEVARD BOULDER CITY NV 89005 (702) 293-4111 10 290012 ST ROSE DOMINICAN HOSPITAL 102 EAST LAKE MEAD DR HENDERSON NV 89015 (702) 616-5000 10 290016 HUMBOLDT GENERAL HOSPITAL 118 EAST HASKELL STREET WINNEMUCCA NV 89445 (775) 623-5222 60 290019 CARSON-TAHOE HOSPITAL 775 FLEISCHMANN WAY CARSON CITY NV 89701 (775) 882-1361 120 290020 NYE REGIONAL MEDICAL CENTER 825 ERIE MAIN ST TONOPAH NV 89049 (775) 482-6233 110 290021 VALLEY HOSPITAL MEDICAL CENTER 620 SHADOW LANE LAS VEGAS NV 89106 (702) 388-4000 10 290022 DESERT SPRINGS HOSPITAL 2075 EAST FLAMINGO ROAD LAS VEGAS NV 89119 (702) 733-8800 10 290027 GROVER C DILS MEDICAL CENTER 700 N SPRING ST, BOX 1010-C-ADM BLDG CALIENTE NV 89008 (775) 726-3171 80 290028 SCHURZ PHS INDIAN HOSPITAL SCHURZ INDIAN HOSPITAL SCHURZ NV 89427 (775) 773-2345 100 290029 OWYHEE COMMUNITY HEALTH FACILITY BOX 212 OWYHEE NV 89832 (775) 757-2415 30 290032 NORTHERN NEVADA MEDICAL CENTER 2375 PRATER WAY SPARKS NV 89431 (775) 331-7000 150 290039 MOUTAINVIEW HOSPITAL 3100 N TENAYA LAS VEGAS NV 89128 (702) 255-5025 10 290041 SUMMERLIN HOSPITAL MEDICAL CENTER 657 TOWN CENTER DRIVE LAS VEGAS NV 89134 (702) 233-7000 10 290042 INTEGRATED HEALTH SERVICES OF LAS VEGA 2170 EAST HARMON AVENUE LAS VEGAS NV 89119 (702) 794-0100 10 290044 STONE CREEK HOSPITAL EAST 4015 SOUTH MCLEOD LAS VEGAS NV 89121 (702) 433-2200 10 290045 ST ROSE DOMINICAN HOSPITAL SIENA CAMP 3001 ST ROSE PARKWAY HENDERSON NV 89052 (702) 616-5000 10 291300 MT GRANT GENERAL HOSPITAL FIRST AND A STREETS PO BOX 1510 HAWTHORNE NV 89415 (775) 945-2461 100 291301 INCLINE VILLAGE HEALT CENTER 880 ALDER STREET INCLINE VILLAGE NV 89451 (775) 833-4100 150 291302 WILLIAM BEE RIRIE HOSPITAL 1500 AVENUE H ELY NV 89301 (775) 289-3001 160 291303 BATTLE MOUNTAIN GENERAL HOSPITAL 535 SOUTH HUMBOLT STREET BATTE MTN NV 89820 (775) 635-2550 70 291304 PERSHING GENERAL HOSPITAL 855 6TH STREET LOVELOCK NV 89419 (775) 273-2621 130 292002 KINDRED HOSPITAL LAS VEGAS 5110 W SAHARA AVE LAS VEGAS NV 89146 (702) 871-1418 10 292003 HORIZON SPECIALTY HOSPITAL 640 DESERT LANE LAS VEGAS NV 89106 (702) 382-3155 10 292004 TAHOE PACIFIC HOSPITAL 2385 PRATER WAY SPARKS NV 89434 (775) 331-1044 150 292005 SELECT SPECIALTY HOSPITAL 235 WEST SIXTH ST RENO NV 89520 (775) 770-3790 10 292006 HEALTHSOUTH HOSPITAL AT TENAYA 2500 TENAYA WAY LAS VEGAS NV 89128 (702) 562-2021 10 293026 HEALTHSOUTH REHAB HOSP OF LAS VEGAS 1250 SOUTH VALLEY VIEW BLVD LAS VEGAS NV 89102 (702) 877-8898 10 293027 HEALTHSOUTH REHAB HOSP OF RENO 555 GOULD ST RENO NV 89502 (775) 348-5500 150 293029 CARSON REHABILITATION CENTER 900 EAST LONG STREET, PO BOX 2305 CARSON CITY NV 89702 (775) 881-7000 120 293030 ACUTE REHABILITATION AT WASHOE 10101 DOUBLE R BLVD RENO NV 89511 (775) 982-7000 150 293032 HEALTHSOUTH REHAB HOSP OF HENDERSON 10301 JEFFREYS AVENUE HENDERSON NV 89052 (702) 939-9400 10 294000 DINI TOWNSEND HOSPITAL NNMH 480 GALLETI WAY SPARKS NV 89431 (702) 486-6250 150 294002 SOUTHERN NEVADA ADULT MENTAL HEALTH 6161 WEST CHARLESTON BLVD LAS VEGAS NV 89102 (702) 486-6238 10 294003 WEST HILLS HOSPITAL 1240 E NINTH ST RENO NV 89515 (702) 323-0478 150 300001 CONCORD HOSPITAL 250 PLEASANT ST CONCORD NH 3301 (603) 225-2711 60 300003 MARY HITCHCOCK MEMORIAL HOSPITAL 1 MEDICAL CENTER DRIVE LEBANON NH 3756 (603) 646-5000 40 300005 LAKES REGION GENERAL HOSPITAL 80 HIGHLAND ST LACONIA NH 3246 (603) 524-3211 0 300006 HUGGINS HOSPITAL SOUTH MAIN STREET WOLFEBORO NH 3894 (603) 569-7500 10 300007 MONADNOCK COMMUNITY HOSPITAL 452 OLD STREET ROAD PETERBOROUGH NH 3458 (603) 924-4699 50 300009 NEW LONDON HOSPITAL ASSOCIATION INC 270 COUNTY ROAD NEW LONDON NH 3257 (603) 526-5512 60 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 83 Provider ID Hospital Name Address City State ZIP Telephone County 300010 SPEARE MEMORIAL HOSPITAL 16 HOSPITAL ROAD PLYMOUTH NH 3264 (603) 536-1120 40 300011 ST JOSEPH HOSPITAL 172 KINSLEY ST NASHUA NH 3060 (603) 882-3000 50 300012 ELLIOT HOSPITAL 1 ELLIOT WAY MANCHESTER NH 3103 (603) 669-5300 50 300013 FRANKLIN REGIONAL HOSPITAL 15 AIKEN AVENUE FRANKLIN NH 3235 (603) 934-2060 60 300014 FRISBIE MEMORIAL HOSPITAL 11 WHITEHALL ROAD ROCHESTER NH 3867 (603) 332-5211 80 300015 MEMORIAL HOSPITAL THE 3073 WHITE MOUNTAIN HIGHWAY NORTH CONWAY NH 3860 (603) 356-5461 10 300016 ALICE PECK DAY MEMORIAL HOSPITAL 125 MASCOMA STREET LEBANON NH 3766 (603) 448-3121 40 300017 PARKLAND MEDICAL CENTER 1 PARKLAND DRIVE DERRY NH 3038 (603) 432-1500 70 300018 WENTWORTH-DOUGLASS HOSPITAL 789 CENTRAL AVE DOVER NH 3820 (603) 742-5252 80 300019 CHESHIRE MEDICAL CENTER,THE 580 COURT STREET KEENE NH 3431 (603) 354-5400 20 300020 SOUTHERN NH MEDICAL CENTER 8 PROSPECT STREET NASHUA NH 3060 (603) 577-2000 50 300022 ANDROSCOGGIN VALLEY HOSPITAL 59 PAGE HILL ROAD BERLIN NH 3570 (603) 752-2200 30 300023 EXETER HOSPITAL INC 10 BUZELL AVENUE EXETER NH 3833 (603) 778-7311 70 300024 VALLEY REGIONAL HOSPITAL 243 ELM ST CLAREMONT NH 3743 (603) 542-7771 90 300029 PORTSMOUTH REGIONAL HOSPITAL 333-343 BORTHWICK AVE, P O BOX 7004 PORTSMOUTH NH 3801 (603) 436-5110 70 300034 CATHOLIC MEDICAL CENTER 100 MCGREGOR STREET MANCHESTER NH 3102 (603) 668-8779 50 301300 UPPER CONNECTICUT VALLEY HOSPITAL CORLISS LANE COLEBROOK NH 3576 (603) 237-4971 30 301301 COTTAGE HOSPITAL SWIFTWATER ROAD PO BOX 2001 WOODSVILLE NH 3785 (603) 747-9000 40 301302 LITTLETON REGIONAL HOSPITAL 600 ST JOHNSBURY ROAD LITTLETON NH 3561 (603) 444-9000 40 301303 WEEKS MEMORIAL HOSPITAL 173 MIDDLE STREET LANCASTER NH 3584 (603) 788-4911 30 303026 NORTHEAST REHABILITATION HOSPITAL 70 BUTLER STREET SALEM NH 3079 (603) 893-2900 70 303027 HEALTHSOUTH REHABILITATION HOSPITAL 254 PLEASANT ST CONCORD NH 3301 (603) 226-9800 60 304000 NEW HAMPSHIRE HOSP-PSYCH UNIT 36 CLINTON STREET CONCORD NH 3301 (603) 271-5300 60 304001 HAMPSTEAD HOSP 218 EAST ROAD HAMPSTEAD NH 3841 (603) 329-5311 70 310001 HACKENSACK UNIVERSITY MEDICAL 30 PROSPECT AVE HACKENSACK NJ 7601 (201) 996-2000 100 310002 NEWARK BETH ISRAEL MEDICAL CENTER 201 LYONS AVE NEWARK NJ 7112 (973) 926-7011 200 310003 PALISADES GENERAL HOSPITAL 7600 RIVER RD NORTH BERGEN NJ 7047 (201) 854-5028 230 310005 HUNTERDON MEDICAL CENTER RT 31 FLEMINGTON NJ 8822 (908) 788-6100 250 310006 ST MARYS HOSPITAL 211 PENNINGTON AVE PASSAIC NJ 7055 (201) 470-3000 320 310008 HOLY NAME HOSPITAL 718 TEANECK RD TEANECK NJ 7666 (201) 833-3000 100 310009 CLARA MAASS MEDICAL CENTER ONE CLARA MAAS DRIVE BELLEVILLE NJ 7109 (201) 450-2000 200 310010 MEDICAL CENTER AT PRINCETON 253 WITHERSPOON ST PRINCETON NJ 8540 (609) 497-4100 260 310011 BURDETE TOMLIN MEMORIAL HOSPITAL TWO STONE HARBOR BLVD CAPE MAY COURT HOUNJ 8210 (609) 463-2047 180 310012 VALLEY HOSPITAL 223 N VAN DIEN AVE RIDGEWOOD NJ 7450 (201) 447-8021 100 310013 IRVINGTON GENERAL HOSPITAL 832 CHANCELLOR AVE IRVINGTON NJ 7111 (201) 399-6000 200 310014 COOPER HOSPITAL/UNIV MEDICAL CENTER 1 COOPER PLAZA CAMDEN NJ 8103 (609) 342-2000 160 310015 MORRISTOWN MEMORIAL HOSPITAL 100 MADISON AVE MORRISTOWN NJ 7960 (201) 971-5177 300 310016 CHRIST HOSPITAL 176 PALISADE AVE JERSEY CITY NJ 7306 (201) 795-8404 230 310017 CHILTON MEMORIAL HOSPITAL 97 W PKWY POMPTON PLAINS NJ 7444 (201) 831-5020 300 310018 ST JAMES HOSPITAL 155 JEFFERSON ST NEWARK NJ 7105 (201) 589-1300 200 310019 ST JOSEPHS HOSPITAL 703 MAIN ST PATERSON NJ 7503 (201) 977-2000 320 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 84 Provider ID Hospital Name Address City State ZIP Telephone County 310020 BETH ISRAEL HOSPITAL 70 PARKER AVE PASSAIC NJ 7055 (201) 365-5000 320 310021 ST FRANCIS MEDICAL CENTER 601 HAMILTON AVE TRENTON NJ 8629 (609) 599-5000 260 310022 WEST JERSEY HOSP CMBND DIVS MT EPHRAIM & ATLANTIC AVES CAMDEN NJ 8104 (609) 246-3200 160 310024 RAHWAY MEMORIAL HOSPITAL 865 STONE ST RAHWAY NJ 7065 (908) 381-4200 370 310025 BAYONNE HOSPITAL 29 EAST 29TH ST BAYONNE NJ 7002 (201) 858-5000 230 310026 BARNERT HOSPITAL 680 BROADWAY PATERSON NJ 7514 (201) 977-6600 320 310027 TRINITAS HOSPITAL 225 WILLIAMSON STREET ELIZABETH NJ 7207 (908) 289-8600 370 310028 NEWTON MEMORIAL HOSPITAL 175 HIGH ST NEWTON NJ 7860 (973) 383-2121 360 310029 OUR LADY OF LOURDES HOSPITAL 1600 HADDON AVENUE CAMDEN NJ 8103 (609) 757-3500 160 310031 DEBORAH HEART & LUNG CENTER 200 TRENTON ROAD BROWNS MILLS NJ 8015 (609) 893-6611 150 310032 SOUTH JERSEY HOSPITAL SYSTEM 333 IRVING AVENUE BRIDGETON NJ 8302 (609) 451-6600 190 310034 RIVERVIEW MEDICAL CENTER ONE RIVERVIEW PLAZA RED BANK NJ 7701 (908) 741-2700 290 310037 PASCACK VALLEY HOSPITAL OLD HOOK ROAD WESTWOOD NJ 7675 (201) 358-3000 100 310038 ROBERT WOOD JOHNSON UNIV HOSP ONE ROBERT WOOD JOHNSON PL NEW BRUNSWICK NJ 8901 (732) 828-3000 270 310039 RARITAN BAY MEDICAL CENTER 530 NEW BRUNSWICK AVE PERTH AMBOY NJ 8861 (908) 442-3700 270 310040 ST MARYS HOSPITAL 308 WILLOW AVE HOBOKEN NJ 7030 (201) 714-8900 230 310041 COMMUNITY MEMORIAL HOSPITAL 99 RT 37 WEST TOMS RIVER NJ 8753 (908) 240-8000 310 310042 WEST HUDSON HOSPITAL 206 BERGEN AVE KEARNY NJ 7032 (201) 955-7000 230 310043 MONTCLAIR COMMUNITY HOSPITAL 120 HARRISON AVE MONTCLAIR NJ 7042 (201) 744-7300 200 310044 MERCER MEDICAL CENTER 446 BELLEVUE AVE TRENTON NJ 8607 (609) 394-4000 260 310045 ENGLEWOOD HOSPITAL & MED CTR 350 ENGLE ST ENGLEWOOD NJ 7631 (201) 894-3000 100 310047 SHORE MEMORIAL HOSPITAL 1 EAST NEW YORK AVE SOMERS POINT NJ 8244 (609) 653-3545 0 310048 SOMERSET MEDICAL CENTER 110 REHILL AVE SOMERVILLE NJ 8876 (908) 685-2200 350 310049 ST FRANCIS COMMUNITY HEALTH CENTER 25 WILLIAMS PL JERSEY CITY NJ 7302 (201) 418-1000 230 310050 ST CLARES HOSPITAL 25 POCONO ROAD DENVILLE NJ 7834 (201) 625-6000 300 310051 OVERLOOK HOSPITAL 99 BEAUVIOR AVE SUMMIT NJ 7902 (908) 522-2000 370 310052 MEDICAL CENTER OF OCEAN COUNTY,THE 425 JACK MARTIN BLVD BRICK NJ 8724 (908) 892-1100 310 310054 MOUNTAINSIDE HOSPITAL BAY AND HIGHLAND AVE MONTCLAIR NJ 7042 (201) 429-6000 200 310057 MEMORIAL HOSPITAL-BURLINGTON COUNTY 175 MADISON AVE MOUNT HOLLY NJ 8060 (609) 267-0700 150 310058 BERGEN PINES COUNTY HOSPITAL 230 EAST RIDGEWOOD AVE PARAMUS NJ 7652 (201) 967-4029 100 310060 WARREN HOSPITAL 185 ROSEBERRY ST PHILLIPSBURG NJ 8865 (908) 859-6702 390 310061 ZURBRUGG MEM HOSP - RANCOCAS VALLEY 218A SUNSET ROAD WILLINGBORO NJ 8046 (609) 835-2900 150 310063 MUHLENBERG REGIONAL MED CTR PARK AVE RANDOLPH ROAD PLAINFIELD NJ 7061 (908) 668-2290 350 310064 ATLANTIC CITY MEDICAL CTR 1925 PACIFIC AVE ATLANTIC CITY NJ 8401 (609) 272-2434 0 310067 SAINT CLARE'S HOSPITAL 400 WEST BLACKWELL STREET DOVER NJ 7801 (201) 989-3042 300 310070 ST PETERS MEDICAL CENTER 254 EASTON AVE NEW BRUNSWICK NJ 8903 (908) 745-8600 270 310073 JERSEY SHORE MEDICAL CENTER 1945 CORLIES AVE NEPTUNE NJ 7753 (908) 775-5500 290 310074 JERSEY CITY MEDICAL CENTER 50 BALDWIN AVE JERSEY CITY NJ 7304 (201) 915-2485 230 310075 MONMOUTH MEDICAL CENTER 300 2ND AVE LONG BRANCH NJ 7740 (908) 870-5100 290 310076 ST BARNABAS MEDICAL CENTER 94 OLD SHORT HILLS RD LIVINGSTON NJ 7039 (201) 533-5900 200 310077 GENERAL HOSPITAL CENTER AT PASSAIC 350 BOULEVARD PASSAIC NJ 7055 (201) 365-4300 320 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 85 Provider ID Hospital Name Address City State ZIP Telephone County 310078 HOSPITAL CENTER AT ORANGE 188 S ESSEX AVE ORANGE NJ 7050 (201) 266-2000 200 310081 UNDERWOOD MEMORIAL HOSPITAL 509 N BROAD ST WOODBURY NJ 8096 (609) 845-0100 220 310083 EAST ORANGE GENERAL HOSPITAL 300 CENTRAL AVE EAST ORANGE NJ 7018 (201) 266-4525 200 310084 KIMBALL MEDICAL CENTER 600 RIVER AVE LAKEWOOD NJ 8701 (908) 370-7419 310 310086 KENNEDY MEM HOSP-UNIVERSITY MED CENTER 113 EAST LAUREL ROAD STRATFORD NJ 8084 (609) 661-5197 160 310088 KESSLER MEMORIAL HOSPITAL 600 SO WHITE HORSE PIKE HAMMONTON NJ 8037 (609) 561-6700 0 310090 UNION HOSPITAL 1000 GALLOPING HILL RD UNION NJ 7083 (908) 687-1900 370 310091 MEMORIAL HOSPITAL OF SALEM COUNTY 310 WOODSTOWN ROAD SALEM NJ 8079 (609) 935-1000 340 310092 CAPITAL HEALTH SYSTEMS AT FULD 750 BRUNSWICK AVE TRENTON NJ 8638 (609) 394-6071 260 310093 COLUMBUS HOSPITAL 495 NORTH 13TH ST NEWARK NJ 7107 (201) 268-1400 200 310096 ST MICHAELS MEDICAL CENTER 268 DR MARTIN LUTHER KING BLVD NEWARK NJ 7102 (201) 877-5000 200 310105 GREENVILLE HOSPITAL 1825 KENNEDY BLVD JERSEY CITY NJ 7305 (201) 547-6100 230 310108 JOHN F KENNEDY MEDICAL CENTER 65 JAMES STREET EDISON NJ 8818 (908) 321-7000 270 310110 RWJ UNIV HOSPIITAL AT HAMILTON ONE HAMILTON HEALTH PLAZA HAMILTON NJ 8690 (609) 584-6405 260 310111 CENTRASTATE MEDICAL CENTER ROUTE 537 W MAIN ST FREEHOLD NJ 7728 (908) 431-2000 290 310112 BAYSHORE COMMUNITY HOSPITAL 727 N BEERS ST HOLMDEL NJ 7733 (732) 739-5900 290 310113 SOUTHERN OCEAN COUNTY HOSPITAL 1140 W BAY AVE MANAHAWKIN NJ 8050 (609) 597-6011 310 310115 HACKETTSTOWN COMMUNITY HOSPITAL 651 WILLOW GROVE ST HACKETTSTOWN NJ 7840 (908) 850-6802 390 310116 WAYNE GENERAL HOSPITAL 224 HAMBURG TNPKE WAYNE NJ 7470 (201) 942-6900 320 310118 MEADOWLANDS HOSPITAL MEDICAL CENTER MEADOWLAND PARKWAY SECAUCUS NJ 7094 (201) 392-3250 230 310119 UMDNJ UNIVERSITY HOSPITL 150 BERGEN ST NEWARK NJ 7103 (201) 982-5658 200 310120 ST CLARE'S HOSPITAL 20 WALNUT ST SUSSEX NJ 7461 (201) 702-2200 360 312002 RUNNELLS SPECIALIZED HOSP-UNION CO 40 WATCHUNG WAY BERKELEY HEIGHTS NJ 7922 (201) 771-5700 370 312014 MATHENY SCHOOL & HOSPITAL,THE MAIN ST PEAPACK NJ 7977 (908) 234-0011 350 313025 KESSLER INSTITUTE FOR REHABILITATION 1199 PLEASANT VALLEY WAY WEST ORANGE NJ 7052 (201) 731-3600 200 313027 ST LAWRENCE REHABILITATION CENTER 2381 LAWRENCEVILLE RD LAWRENCEVILLE NJ 8648 (609) 896-9500 260 313029 HEALTHSOUTH GARDEN STATE REHAB HOSP 14 HOSPITAL DRIVE TOMS RIVER NJ 8753 (732) 244-3100 310 313030 BETTY BACHARACH REHAB CENTER 61 W JIMMIE LEEDS RD POMONA NJ 8240 (609) 748-5460 0 313032 MEDIPLEX REHABILITATION HOSP-MARL 300 BRICK ROAD MARLTON NJ 8053 (609) 988-8778 150 313033 SHORE REHABILITATION INSTITUTE 2121 EDGEWATER PLACE POINT PLEASANT NJ 8742 (732) 295-6500 310 313034 VOORHEES PEDIATRIC HOSPITAL 92 BRICK ROAD, 3RD FLOOR MARLTON NJ 8053 (609) 489-4520 150 313035 REHAILITATION HOSPITAL OF TINTON FALLS 2 CENTRE PLAZA TINTON FALLS NJ 7724 (732) 460-5320 290 313300 CHILDRENS SPECIALIZED HOSP 150 NEW PROVIDENCE ROAD MOUNTAINSIDE NJ 7092 (908) 233-3720 370 314001 SUMMIT HOSPITAL 19 PROSPECT ST SUMMIT NJ 7901 (908) 522-7000 370 314005 ANCORA PSYCH HOSP ANCORA BRANCH HAMMONTON NJ 8037 (609) 561-1700 0 314010 MOUNT CARMEL GUILD 1160 RAYMOND BLVD NEWARK NJ 7102 (973) 596-4100 200 314011 UNIVERSITY BEHAVIORAL HEALTHCARE HOES LANE PISCATAWAY NJ 8854 (732) 235-5900 270 314012 CARRIER CLINIC FOUNDATION P O BOX 147 BELLE MEAD NJ 8502 (201) 874-4000 350 314013 TRENTON PSYCHIATRIC HOSP STATION A TRENTON NJ 8625 (609) 633-1586 260 314016 GREYSTONE PARK PSYCH HOSP CENTRAL AVE GREYSTONE PARK NJ 7950 (973) 538-1800 300 314017 SEN GARRETT W HAGEDORN GEROPSYCHIATRIC MT KIPP GLEN GARDNER NJ 8826 (908) 537-2141 250 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 86 Provider ID Hospital Name Address City State ZIP Telephone County 314018 CAMDEN CO HEALTH SERVICES CENTER P O BLACKWOOD LAKELAND NJ 8012 (609) 374-6600 160 314019 RAMAPO RIDGE PSYCH HOSP 301 SYCOMAC AVE WYCKOFF NJ 7481 (201) 848-5805 100 314020 ESSEX COUNTY HOSPITAL CENTER 125 FAIRVIEW AVENUE CEDAR GROVE NJ 7009 (973) 228-8202 200 314021 HAMPTON BEHAVIORAL HEALTH SYSTEM 650 RANCOCAS ROAD WESTAMPTON NJ 8060 (609) 267-7000 150 314022 SHORELINE BEHAVIORAL CENTER 1691 HIGHWAY 9 TOMS RIVER NJ 8755 (908) 914-1688 310 314023 BUTTONWOOD HOSPITAL OF BURLINGTON CO 600 PEMBERTON BROWNS MILL ROAD NEW LISBON NJ 8064 (609) 726-7000 150 314024 HUDSON COUNTY MEADOWVIEW PSYCHIATRIC H 595 COUNTY AVENUE SECAUCUS NJ 7094 (201) 319-3660 230 314025 ANNE KLEIN FORENSIC CENTER PO BOX 7717 STUYVESANT AVE TRENTON NJ 8628 (609) 633-0900 260 320001 UNIVERSITY OF NEW MEXICO HOSPITAL 2211 LOMAS BLVD N E ALBUQUERQUE NM 87106 (505) 843-2121 0 320002 ST VINCENT HOSPITAL 455 ST MICHAEL'S DRIVE SANTA FE NM 87502 (505) 983-3361 240 320003 NORTHEASTERN REGIONAL HOSPITAL 1235 8TH ST LAS VEGAS NM 87701 (505) 425-6751 230 320004 GERALD CHAMPION REGIONAL MEDICAL CENTE 2669 NORTH SCENIC DRIVE ALAMOGORDO NM 88310 (505) 439-2100 170 320005 SAN JUAN REGIONAL MEDICAL CENTER INC 801 WEST MAPLE STREET FARMINGTON NM 87401 (505) 325-5011 220 320006 EASTERN NEW MEXICO MEDICAL CENTER 405 W COUNTRY CLUB RD ROSWELL NM 88201 (505) 622-8170 20 320009 ST JOSEPH MEDICAL CENTER 601 DR MARTIN LUTHER KING JR AVE NE ALBUQUERQUE NM 87102 (505) 224-8000 0 320011 ESPANOLA HOSPITAL 1010 SPRUCE STREET ESPANOLA NM 87532 (505) 753-7111 190 320013 HOLY CROSS HOSPITAL 1397 WEIMER ROAD TAOS NM 87571 (505) 758-8883 270 320014 MIMBRES MEMORIAL HOSPITAL 900 W ASH DEMING NM 88030 (505) 546-2761 140 320016 GILA REGIONAL MEDICAL CENTER 1313 2ND ST PO BOX 2767 SILVER CITY NM 88061 (505) 388-1591 80 320017 ST JOSEPH NORTHEAST HEIGHTS HOSPITAL 4701 MONTGOMERY BLVD NE ALBUQUERQUE NM 87109 (505) 888-7800 0 320018 MEMORIAL MEDICAL CENTER INC 2450 SOUTH TELSHOR BLVD LAS CRUCES NM 88001 (505) 522-8641 60 320019 LOVELACE HEALTH SYSTEMS INC 5400 GIBSON BLVD SE ALBUQUERQUE NM 87108 (505) 262-7000 0 320021 PRESBYTERIAN HOSPITAL 1100 CENTRAL AVE SE ALBUQUERQUE NM 87106 (505) 841-1234 0 320022 PLAINS REGIONAL MEDICAL CENTER CLOVIS 2100 NORTH THOMAS CLOVIS NM 88101 (505) 769-2141 40 320030 ARTESIA GENERAL HOSPITAL 702 N 13TH ST ARTESIA NM 88210 (505) 748-3333 70 320033 LOS ALAMOS MEDICAL CENTER 3917 WEST ROAD LOS ALAMOS NM 87544 (505) 662-4201 131 320037 CIBOLA GENERAL HOSPITAL 1016 ROOSEVELT AVENUE GRANTS NM 87020 (505) 287-4446 25 320038 REHOBOTH MCKINLEY CHRISTIAN HEALTH SER 1901 RED ROCK DRIVE GALLUP NM 87301 (505) 863-7000 150 320046 LINCOLN COUNTY MEDICAL CENTER 211 SUDDERTH RUIDOSO NM 88345 (505) 257-7381 130 320056 PHS INDIAN HOSPITAL 801 VASSAR DR NE ALBUQUERQUE NM 87106 (505) 256-4062 0 320057 PHS INDIAN HOSPITAL 1700 CERRILLOS ROAD SANTA FE NM 87501 (505) 988-9821 240 320058 PHS INDIAN HOSPITAL P O BOX 210 MESCALERO NM 88340 (505) 671-4441 170 320059 PHS INDIAN HOSPITAL P O BOX 160 SHIPROCK NM 87420 (505) 368-4971 220 320060 ZUNI PHS INDIAN HOSPITAL P O BOX 467 ZUNI NM 87327 (505) 782-4431 150 320061 GALLUP INDIAN MEDICAL CENTER P O BOX 1377 GALLUP NM 87301 (505) 722-1000 150 320062 PHS INDIAN HOSPITAL P O BOX 358 CROWNPOINT NM 87313 (505) 786-5291 150 320063 CARLSBAD MEDICAL CENTER 2340 W PIERCE CARLSBAD NM 88220 (505) 887-4100 70 320065 LEA REGIONAL HOSPITAL 5419 LOVINGTON HWY P O BOX 3000 HOBBS NM 88240 (505) 392-6581 120 320067 GUADALUPE COUNTY HOSPITAL 535 LAKE DRIVE SANTA ROSA NM 88435 (505) 472-3417 90 320068 NOR LEA GENERAL HOSPITAL 1600 NORTH MAIN LOVINGTON NM 88260 (505) 396-6611 120 320069 MINERS' COLFAX MEDICAL CENTER 200 HOSPITAL DRIVE RATON NM 87740 (505) 445-3661 30 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 87 Provider ID Hospital Name Address City State ZIP Telephone County 320070 ACOMA CANONCITO LAQUNA PHS HOSPITAL P O BOX 130 SAN FIDEL NM 87049 (505) 552-6634 25 320074 ST JOSEPH WEST MESA HOSPITAL 10501 GOLF COURSE RD NW ALBUQUERQUE NM 87114 (505) 848-8000 0 320079 KASEMAN PRESBY HOSP 8300 CONSTITUTION NE ALBUQUERQUE NM 87110 (505) 291-2000 0 320083 HEART HOSPITAL OF NEW MEXICO 504 ELM STREET ALBUQUERQUE NM 87102 (505) 242-5600 0 320084 ROOSEVELT GENERAL HOSPITAL 42121 US HIGHWAY 70 PORTALES NM 88130 (505) 359-1800 200 321300 SIERRA VISTA HOSPITAL 800 E NINTH AVENUE T OR C NM 87901 (505) 894-2111 250 321301 SOCORRO GENERAL HOSPITAL 1202 HIGHWAY 60 WEST SOCORRO NM 87801 (505) 835-1140 260 321302 DR DAN C TRIGG MEMORIAL HOSPITAL 301 EAST MIEL DE LUNA/PO BOX 608 TUCUMCARI NM 88401 (505) 461-0141 180 321304 UNION COUNTY GENERAL HOSPITAL 301 HARDING STREET CLAYTON NM 88415 (505) 374-2585 20 321305 NOR LEA GENERAL HOSPITAL DISTRICT 1600 NORTH MAIN LOVINGTON NM 88260 (505) 396-6611 120 322002 KINDRED HOSPITAL ALBUQUERQUE 700 HIGH ST NE ALBUQUERQUE NM 87102 (505) 242-4444 0 322003 INTEGRATED SPECIALTY HOSPITAL OF ALBUQ 235 ELM ST NE ALBUQUERQUE NM 87102 (505) 842-5550 0 323026 NEW MEXICO REHABILITATION CENTER 31 GAIL HARRIS AVENUE ROSWELL NM 88201 (505) 347-5491 20 323027 HEALTHSOUTH REHABILITATION HOSPITAL 7000 JEFFERSON NE ALBUQUERQUE NM 87109 (505) 344-9478 0 323028 ST JOSEPH REHAB HOSP AND OUTPATIENT CT 505 ELM STREET NE ALBUQUERQUE NM 87102 (505) 224-2709 0 323029 LIFECOURSE CENTER FOR REHAB SERVICES 525 SOUTH SCHWARTZ AVENUE FARMINGTON NM 87401 (505) 327-3422 220 323307 CARRIE TINGLEY HOSPITAL 1127 UNIVERSITY BLVD NE ALBUQUERQUE NM 87102 (505) 272-5200 0 324004 MEMORIAL HOSPITAL 806 CENTRAL AVE SE ALBUQUERQUE NM 87102 (505) 247-0220 0 324007 ALLIANCE HOSPITAL OF SANTA TERESA 100 LAURA COURT BOX 6 SANTA TERESA NM 88008 (505) 589-0033 60 324010 MESILLA VALLEY HOSP 3751 DEL REY BOULEVARD LAS CRUCES NM 88001 (505) 382-3500 60 330001 HORTON MEMORIAL HOSPITAL 60 PROSPECT AVE MIDDLETOWN NY 10940 (914) 343-2424 540 330002 PENINSULA HOSPITAL CENTER 51-15 BEACH CHANNEL DRIVE FAR ROCKAWAY NY 11691 (718) 945-7100 590 330003 ALBANY MEMORIAL HOSPITAL 600 NORTHERN BLVD ALBANY NY 12204 (518) 471-3221 0 330004 KINGSTON HOSPITAL 396 BROADWAY KINGSTON NY 12401 (914) 331-3131 740 330005 KALEIDA HEALTH 100 HIGH ST BUFFALO NY 14203 (716) 843-7500 240 330006 ST JOSEPHS HOSPITAL 127 S BROADWAY YONKERS NY 10701 (914) 378-7000 800 330008 WYOMING COUNTY COMMUNITY HOSPITAL 400 N MAIN ST WARSAW NY 14569 (716) 786-2233 900 330009 BRONX-LEBANON HOSPITAL CENTER 1276 FULTON AVE BRONX NY 10456 (212) 588-7000 20 330010 AMSTERDAM MEMORIAL HOSPITAL 4988 STATE HIGHWAY 30 AMSTERDAM NY 12010 (518) 842-3100 380 330011 OUR LADY OF LOURDES MEM HOSPITAL 169 RIVERSIDE DRIVE BINGHAMTON NY 13905 (607) 798-5111 30 330013 ALBANY MEDICAL CENTER NEW SCOTLAND AV ALBANY NY 12208 (518) 445-3760 0 330014 JAMAICA HOSPITAL 89TH AVE AND VAN WYCK EXPRESSWAY JAMAICA NY 11418 (718) 262-6000 590 330016 HOSPITAL,THE PEARL ST SIDNEY NY 13838 (607) 563-3512 220 330019 NEW YORK COMMUNITY HOSP OF BR00KLYN 2525 KINGS HIGHWAY BROOKLYN NY 11229 (718) 692-5302 331 330020 MARY MCCLELLAN HOSPITAL 1 MYRTLE AVE CAMBRIDGE NY 12816 (518) 677-2611 760 330023 VASSAR BROTHERS HOSPITAL READE PLACE POUGHKEEPSIE NY 12601 (914) 454-8500 230 330024 MT SINAI HOSPITAL ONE GUSTAVE L LEVY PLACE NEW YORK NY 10029 (212) 241-6500 420 330025 INTER COMMUNITY MEMORIAL HOSPITAL 2600 WILLIAM ST NEWFANE NY 14108 (716) 778-5111 500 330027 NASSAU COUNTY MEDICAL CENTER 2201 HEMPSTEAD TNPK EAST MEADOW NY 11554 (516) 572-6051 400 330028 SISTERS OF CHARITY MEDICAL CENTERD 75 VANDERBILT AVENUE STATEN ISLAND NY 10304 (718) 354-5047 610 330029 SHEEHAN MEMORIAL HOSPITAL 425 MICHIGAN AVE BUFFALO NY 14203 (716) 842-2200 240 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 88 Provider ID Hospital Name Address City State ZIP Telephone County 330030 VIAHEALTH OF WAYNE DRIVING PARK AVE PO BOX 111 NEWARK NY 14513 (315) 332-2022 770 330033 CHENANGO MEMORIAL HOSPITAL 179 N BROAD ST NORWICH NY 13815 (607) 335-4111 80 330036 DOBBS FERRY HOSPITAL 128 ASHFORD AVE DOBBS FERRY NY 10522 (914) 693-0700 800 330037 LAKESIDE MEMORIAL HOSPITAL 156 WEST AVE BROCKPORT NY 14420 (716) 637-3131 370 330041 PARKWAY HOSPITAL 70-35 113TH ST FOREST HILLS NY 11375 (718) 990-4131 590 330043 SOUTHSIDE HOSPITAL 301 EAST MAIN STREET BAY SHORE NY 11706 (516) 968-3000 700 330044 ST LUKES MEMORIAL HOSPITAL CENTER BOX 479 UTICA NY 13503 (315) 798-6000 510 330045 HUNTINGTON HOSPITAL 270 PARK AVE HUNTINGTON NY 11743 (516) 351-2000 700 330046 ST LUKES - ROOSEVELT HOSPITAL 1111 AMSTERDAM AVENUET NEW YORK NY 10025 (212) 523-4000 420 330047 ST MARYS HOSPITAL 427 GUY PARK AVE AMSTERDAM NY 12010 (518) 842-1900 380 330049 NORTHERN DUTCHESS HOSPITAL SPRINGBROOK AVE RHINEBECK NY 12572 (914) 876-3001 230 330053 MEDINA MEMORIAL HOSPITAL 500 OHIO STREET MEDINA NY 14103 (716) 798-2000 550 330055 NY HOSPITAL MEDICAL CTR OF QUEENS,THE 56-45 MAIN STREET FLUSHING NY 11355 (718) 670-1231 590 330056 BROOKLYN - CALEDONIAN HOSP 121 DEKALB AVE BROOKLYN NY 11201 (718) 250-8000 331 330057 ST PETERS HOSPITAL 315 SOUTH MANNING BLVD ALBANY NY 12208 (518) 454-1550 0 330058 GENEVA GENERAL HOSPITAL 196 198 NORTH ST GENEVA NY 14456 (315) 789-4222 530 330059 MONTEFIORE MEDICAL CENTER 111 E 210TH ST BRONX NY 10467 (718) 920-4321 20 330061 LAWRENCE HOSPITAL 55 PALMER AVE BRONXVILLE NY 10708 (914) 337-7300 800 330062 SCHUYLER HOSPITAL MONTOUR TOWNSEND RD P O BOX 307 MONTOUR FALLS NY 14865 (607) 535-7121 670 330064 NYU DOWNTOWN HOSPITAL 170 WILLIAM ST NEW YORK NY 10038 (212) 312-5000 420 330065 NIAGARA FALLS MEMORIAL MED CENTER 621 10TH ST NIAGARA FALLS NY 14302 (716) 278-4000 500 330066 ST CLARES HOSPITAL 600 MCCLELLAN ST SCHENECTADY NY 12304 (518) 382-2000 650 330067 ST FRANCIS HOSPITAL NORTH RD POUGHKEEPSIE NY 12601 (914) 471-2000 230 330072 OUR LADY OF MERCY MED CTR FLOR D'URSO 600 EAST 233RD STREET BRONX NY 10466 (718) 920-9000 20 330073 UNITED MEMORIAL MEDICAL CENTER 127 NORTH ST BATAVIA NY 14020 (716) 343-6030 290 330074 F F THOMPSON HOSPITAL 350 PARRISH ST CANANDAIGUA NY 14424 (716) 396-6000 530 330075 ALBERT LINDLEY LEE MEMORIAL HOSPITAL 500 S FOURTH ST FULTON NY 13069 (315) 592-2224 560 330076 STATEN ISLAND UNIVERSITY HOSPITAL-SOUT 375 SEQUINE AVE STATEN ISLAND NY 10309 (718) 317-2000 610 330078 SISTERS OF CHARITY HOSPITAL 2157 MAIN ST BUFFALO NY 14214 (716) 862-2000 240 330079 ADIRONDACK MEDICAL CENTER LAKE COLBY DRIVE SARANAC LAKE NY 12983 (518) 891-4141 270 330080 LINCOLN MEDICAL & MENTAL HLTH CENTER 234 EAST 149TH ST BRONX NY 10454 (718) 579-5000 20 330084 ALICE HYDE MEMORIAL HOSPITAL 115 PARK ST MALONE NY 12953 (518) 483-3000 270 330085 A O FOX MEMORIAL HOSPITAL ONE NORTON AVE ONEONTA NY 13820 (607) 423-2000 570 330086 MT VERNON HOSPITAL 12 N 7TH AVE MOUNT VERNON NY 10550 (914) 664-8000 800 330088 EASTERN LONG ISLAND HOSPITAL 201 MANOR PLACE GREENPORT NY 11944 (631) 477-1000 700 330090 ARNOT OGDEN MEDICAL CENTER ROE AVE GROVE ST ELMIRA NY 14901 (607) 737-4100 70 330091 ST JOSEPH INTERCOMMUNITY HOSPITAL 2605 HARLEM RD CHEEKTOWAGA NY 14225 (716) 891-2400 240 330094 COLUMBIA GREENE MEDICAL CENTER INC 159 JEFFERSON HEIGHTS CATSKILL NY 12414 (518) 943-2000 300 330095 OUR LADY OF VICTORY 55 MELROY AT RIDGE ROAD LACKAWANNA NY 14218 (716) 825-8000 240 330096 JONES MEMORIAL HOSPITAL 191 N MAIN ST WELLSVILLE NY 14895 (716) 593-1100 10 330097 SOLDIERS & SAILORS MEMORIAL HOSPITAL 418 N MAIN ST PENN YAN NY 14527 (315) 536-4431 910 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 89 Provider ID Hospital Name Address City State ZIP Telephone County 330100 NEW YORK EYE AND EAR INFIRMARY 310 E 14TH ST NEW YORK NY 10003 (212) 979-4000 420 330101 NEW YORK HOSPITAL 525 E 68TH ST NEW YORK NY 10021 (212) 472-5454 420 330102 KENMORE MERCY HOSPITAL 2950 ELMWOOD AVE KENMORE NY 14217 (716) 879-6100 240 330103 OLEAN GENERAL HOSPITAL WEST 2221 WEST STATE STREET OLEAN NY 14760 (716) 373-2600 40 330104 NYACK HOSPITAL NORTH MEDLAND AVE NYACK NY 10960 (914) 348-2000 620 330106 NORTH SHORE UNIVERSITY HOSPITAL 300 COMMUNITY DRIVE MANHASSET NY 11030 (516) 562-4050 400 330107 CENTRAL SUFFOLK HOSPITAL 1300 ROANOKE AVE RIVERHEAD NY 11901 (516) 548-6000 700 330108 ST JOSEPHS HOSPITAL 555 E MARKET ST ELMIRA NY 14902 (607) 733-6541 70 330111 BERTRAND CHAFFEE HOSPITAL 224 E MAIN ST SPRINGVILLE NY 14141 (716) 592-2871 240 330114 E J NOBLE-ALEXANDRIA BAY FULLER STREET ALEXANDRIA BAY NY 13607 (315) 482-2511 330 330115 ONEIDA CITY HOSPITAL 321 GENESSE ST ONEIDA NY 13421 (315) 363-6000 360 330119 LENOX HILL HOSPITAL 100 E 77TH ST NEW YORK NY 10021 (212) 439-2345 420 330121 DELAWARE VALLEY HOSPITAL INC 1 TITUS PLACE WALTON NY 13856 (607) 865-4101 220 330125 ROCHESTER GENERAL HOSPITAL 1425 PORTLAND AVE ROCHESTER NY 14621 (716) 338-4000 370 330126 ARDEN HILL HOSPITAL 4 HARRIMAN DRIVE GOSHEN NY 10924 (845) 294-5441 540 330127 JACOBI MEDICAL CENTER PELHAM PKWY & EASTCHESTER RD BRONX NY 10461 (212) 430-8141 20 330128 CITY HOSPITAL CENTER AT ELMHURST 79-01 BROADWAY FLUSHING NY 11373 (718) 334-1141 590 330132 TLC HEALTH NETWORK 100 MEMORIAL DR GOWANDA NY 14070 (716) 532-3377 40 330133 CABRINI MEDICAL CENTER 227 E 19TH ST NEW YORK NY 10003 (212) 995-6000 420 330135 BON SECOURS COMMUNITY HOSPITAL 160 E MAIN ST PORT JERVIS NY 12771 (914) 856-5351 540 330136 MARY IMOGENE BASSETT HOSPITAL,THE ONE ATWELL RD COOPERSTOWN NY 13326 (607) 547-3456 570 330140 ST JOSEPHS HOSPITAL HEALTH CENTER 301 PROSPECT AVE SYRACUSE NY 13203 (315) 448-5111 520 330141 BROOKHAVEN MEMORIAL HOSPITAL 101 HOSPITAL ROAD PATCHOGUE NY 11772 (516) 654-7100 700 330144 IRA DAVENPORT MEMORIAL HOSPITAL BOX 350 ROUTE 54 BATH NY 14810 (607) 776-2141 690 330148 LITTLE FALLS HOSPITAL 140 BURWELL ST LITTLE FALLS NY 13365 (315) 823-1000 320 330151 ST JAMES MERCY HOSPITAL 411 CANISTED ST HORNELL NY 14843 (607) 324-3900 690 330152 LONG ISLAND COLLEGE HOSPITAL 340 HENRY ST BROOKLYN NY 11201 (718) 780-4651 331 330153 ELLIS HOSPITAL 1101 NOTT ST SCHENECTADY NY 12308 (518) 382-4124 650 330154 MEMORIAL HOSPITAL FOR CANCER AND ALLIE 1275 YORK AVE NEW YORK NY 10021 (212) 639-2000 420 330157 SAMARITAN MEDICAL CENTER 830 WASHINGTON ST WATERTOWN NY 13601 (315) 785-4121 330 330158 GOOD SAMARITAN HOSPITAL OF SUFFERN 255 LAFAYETTE AVENUE SUFFERN NY 10901 (914) 368-5000 620 330159 COMMUNITY GENERAL HOSPITAL BROAD RD SYRACUSE NY 13215 (315) 492-5731 520 330160 STATEN ISLAND UNIVERSITY HOSPITAL 475 SEAVIEW AVE STATEN ISLAND NY 10305 (718) 226-9000 610 330162 NORTHERN WESTCHESTER HOSPITAL 380 MAIN ST MOUNT KISCO NY 10549 (914) 666-1200 800 330163 LOCKPORT MEMORIAL HOSPITAL 521 EAST AVE LOCKPORT NY 14094 (716) 434-9111 500 330164 HIGHLAND HOSPITAL 1000 SOUTH AVENUE ROCHESTER NY 14620 (716) 473-2200 370 330166 WESTFIELD MEMORIAL HOSPITAL 189 E MAIN ST WESTFIELD NY 14787 (716) 326-4921 60 330167 WINTHROP UNIVERSITY HOSPITAL 259 1ST ST MINEOLA NY 11501 (516) 663-2311 400 330169 BETH ISRAEL MEDICAL CENTER FIRST AVENUE & 16TH STREET NEW YORK NY 10003 (212) 420-2000 420 330171 UNITED HOSPITAL MEDICAL CENTER 406 BOSTON POST RD PORT CHESTER NY 10573 (914) 939-7000 800 330175 CORTLAND MEMORIAL HOSPITAL 134 HOMER AVE CORTLAND NY 13045 (607) 756-3500 210 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 90 Provider ID Hospital Name Address City State ZIP Telephone County 330177 E J NOBLE-GOUVERNEUR 77 W BARNEY ST GOUVERNEUR NY 13642 (315) 287-1000 630 330180 SAMARITAN HOSPITAL 2215 BURDETT AVE TROY NY 12180 (518) 271-3225 600 330181 NORTH SHORE UNIV HOSP AT GLEN COVE ST ANDREWS LANE GLEN COVE NY 11542 (516) 676-5000 400 330182 ST FRANCIS HOSPITAL PORT WASHINGTON BLVD ROSLYN NY 11576 (516) 562-6902 400 330183 GENESEE HOSPITAL 244 ALEXANDER ST ROCHESTER NY 14607 (716) 263-6000 370 330184 SOUND SHORE MEDICAL CENTER 16 GUION PLACE NEW ROCHELLE NY 10802 (914) 632-5000 800 330185 JOHN T MATHER MEMORIAL HOSPITAL NORTH COUNTRY RD PORT JEFFERSON NY 11777 (516) 473-1320 700 330188 MT ST MARYS HOSP OF NIAGARA FALLS 5300 MILITARY RD LEWISTON NY 14092 (716) 297-4800 500 330189 ALBANY MEDICAL CENTER SOUTH CLINICAL CAMPUS ALBANY NY 12208 (518) 242-1461 0 330191 GLENS FALLS HOSPITAL 100 PARK STREET GLENS FALLS NY 12801 (518) 792-3151 750 330193 FLUSHING HOSPITAL MEDICAL CENTER 45TH AVE AND PARSONS BLVD FLUSHING NY 11355 (718) 670-5000 590 330194 MAIMONIDES MEDICAL CENTER 4802 TENTH AVE BROOKLYN NY 11219 (718) 283-8313 331 330195 LONG ISLAND JEWISH MEDICAL CENTER 270-05 76TH AVE NEW HYDE PARK NY 11042 (718) 470-7620 400 330196 CONEY ISLAND HOSPITAL 2601 OCEAN PKWY BROOKLYN NY 11235 (718) 615-4000 331 330197 CANTON POTSDAM HOSPITAL POTSDAM HOSP UNIT-50 LEROY ST POTSDAM NY 13676 (315) 265-3300 630 330198 SOUTH NASSAU COMMUNITY HOSPITAL 2445 OCEANSIDE RD OCEANSIDE NY 11572 (516) 763-2030 400 330199 METROPOLITAN HOSPITAL CENTER 1901 1ST AVE NEW YORK NY 10029 (212) 230-6262 420 330201 KINGSBROOK JEWISH MEDICAL CENTER 585 SCHENECTADY AVE BROOKLYN NY 11203 (718) 604-5000 331 330202 KINGS COUNTY HOSPITAL CENTER 451 CLARKSON AVE BROOKLYN NY 11203 (718) 245-3901 331 330203 CROUSE-IRVING MEMORIAL HOSPITAL 736 IRVING AVE SYRACUSE NY 13210 (315) 470-7449 520 330204 BELLEVUE HOSPITAL CENTER 1ST AVE & 27TH ST NEW YORK NY 10016 (212) 561-4132 420 330205 ST ANTHONY COMMUNITY HOSPITAL 15-19 MAPLE AVE WARWICK NY 10990 (914) 986-2276 540 330208 ST JOHNS RIVERSIDE HOSPITAL 976 N BROADWAY YONKERS NY 10701 (914) 964-4444 800 330209 ST LUKES HOSPITAL 70 DUBOIS ST NEWBURGH NY 12550 (914) 561-4400 540 330211 CLAXTON HEPBURN MEDICAL CENTER 214 KING ST OGDENSBURG NY 13669 (315) 393-3600 630 330212 STATEN ISLAND UNIVERSITY HOSPITAL CONC 1050 TARGEE STATEN ISLAND NY 10304 (718) 390-1400 610 330213 LEWIS COUNTY GENERAL HOSPITAL 7785 NORTH STATE ST LOWVILLE NY 13367 (315) 376-5200 340 330214 NYU MED CENTER-UNIVERSITY HOSPITAL 550 FIRST AVE NEW YORK NY 10016 (212) 263-5500 420 330215 ROME HOSPITAL & MURPHY MEM HOSPITAL 1500 N JAMES ST ROME NY 13440 (315) 338-7000 510 330218 OSWEGO HOSPITAL 110 W 6TH ST OSWEGO NY 13126 (315) 349-5511 560 330219 ERIE COUNTY MEDICAL CENTER 462 GRIDER ST BUFFALO NY 14215 (716) 898-3936 240 330221 WYCKOFF HEIGHTS HOSPITAL 374 STOCKHOLM ST BROOKLYN NY 11237 (718) 963-7272 331 330222 SARATOGA HOSPITAL 211 CHURCH ST SARATOGA SPRINGS NY 12866 (518) 587-3222 640 330223 MASSENA MEMORIAL HOSPITAL ONE HOSPITAL DRIVE MASSENA NY 13662 (315) 764-1711 630 330224 BENEDICTINE HOSPITAL 105 MARYS AVE KINGSTON NY 12401 (914) 338-2500 740 330225 LONG BEACH MEMORIAL HOSPITAL 455 E BAY DR LONG BEACH NY 11561 (516) 897-1000 400 330226 PARK RIDGE HOSPITAL 1555 LONG POND RD ROCHESTER NY 14626 (716) 723-7000 370 330229 BROOKS MEMORIAL HOSPITAL 529 CENTRAL AVE DUNKIRK NY 14048 (716) 366-1111 60 330230 ST CLARES HOSPITAL HEALTH CENTER 415 W 51ST ST NEW YORK NY 10019 (212) 586-1500 420 330231 QUEENS HOSPITAL CENTER 82-68 164TH ST JAMAICA NY 11432 (718) 883-2350 590 330232 SETON HEALTH SYSTEMS INC 1300 MASSACHUSETTS AV TROY NY 12180 (518) 272-5000 600 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 91 Provider ID Hospital Name Address City State ZIP Telephone County 330233 BROOKDALE HOSPITAL MEDICAL CENTER LINDEN BLVD BROOKLYN NY 11212 (718) 240-5000 331 330234 WESTCHESTER COUNTY MEDICAL CENTER GRASSLANDS RESERVATION VALHALLA NY 10595 (914) 285-7017 800 330235 AUBURN MEMORIAL HOSPITAL 5-21 LANSING ST AUBURN NY 13021 (315) 255-7011 50 330236 NEW YORK METHODIST HOSPITAL,THE 506 SIXTH ST BROOKLYN NY 11215 (718) 780-3000 331 330238 NICHOLAS NOYES MEMORIAL HOSPITAL 111 CLARA BARTON ST DANSVILLE NY 14437 (716) 335-6001 350 330239 WOMANS CHRISTIAN ASSOC HOSPITAL 207 FOOTE AVE JAMESTOWN NY 14701 (716) 487-0141 60 330240 HARLEM HOSPITAL CENTER 506 LENOX AVE NEW YORK NY 10037 (212) 491-8400 420 330241 SUNY UPSTATE MEDICAL CENTER 750 E ADAMS ST SYRACUSE NY 13210 (315) 473-4240 520 330242 VICTORY MEMORIAL HOSPITAL 9036 7TH AVE BROOKLYN NY 11228 (718) 630-1234 331 330245 ST ELIZABETHS HOSPITAL 2209 GENESEE ST UTICA NY 13501 (315) 798-8100 510 330246 ST CHARLES HOSPITAL 200 BELLE TERRE RD PORT JEFFERSON NY 11777 (516) 474-6600 700 330247 MANHATTAN EYE EAR THROAT HOSPITAL 210 E 64TH ST NEW YORK NY 10021 (212) 605-3770 420 330249 COMMUNITY MEMORIAL HOSPITAL 150 BROAD ST HAMILTON NY 13346 (315) 824-1100 360 330250 CHAMPLAIN VALLEY PHYSICIANS HOSPITAL 100 BEEKMAN ST PLATTSBURGH NY 12901 (518) 561-2000 90 330254 MYERS COMMUNITY HOSPITAL MIDDLE RD PO BOX 310 SODUS NY 14551 (315) 483-9161 770 330258 WESTERN QUEENS COMMUNITY HOSPITAL 2510 30TH AVE LONG ISLAND CITY NY 11102 (718) 932-1000 590 330259 MERCY MEDICAL CENTER 1000 N VILLAGE AVE ROCKVILLE CENTRE NY 11570 (516) 255-0111 400 330261 PHELPS MEMORIAL HOSPITAL 701 NORTH BROADWAY NORTH TARRYTOWN NY 10591 (914) 366-3000 800 330263 CARTHAGE AREA HOSPITAL WEST ST RD CARTHAGE NY 13619 (315) 493-1000 330 330264 CORNWALL HOSPITAL,THE LAUREL AVE CORNWALL NY 12518 (914) 534-7711 540 330265 CLIFTON SPRINGS HOSPITAL 2 COULER RD CLIFTON SPRINGS NY 14432 (315) 462-9561 530 330267 HUDSON VALLEY HOSPITAL CENTER 1980 CROMPOND RD PEEKSKILL NY 10566 (914) 737-9000 800 330268 BASSETT HOSPITAL OF SCHOHARIE COUNTY 178 GRANDVIEW DR COBLESKILL NY 12043 (518) 234-2511 660 330270 HOSPITAL FOR SPECIAL SURGERY 535 E 70TH ST NEW YORK NY 10021 (212) 606-1000 420 330273 PUTNAM HOSPITAL CENTER STONELEIGH AVE CARMEL NY 10512 (914) 279-5711 580 330275 ST MARYS HOSPITAL 89 GENESEE ST ROCHESTER NY 14611 (716) 464-3000 370 330276 NATHAN LITTAUER HOSPITAL 99 E STATE ST GLOVERSVILLE NY 12078 (518) 725-8621 280 330277 CORNING HOSPITAL 176 DENISON PARKWAY EAST CORNING NY 14830 (607) 937-7200 690 330279 MERCY HOSPITAL 565 ABBOTT RD BUFFALO NY 14220 (716) 826-7000 240 330285 STRONG MEMORIAL HOSPITAL 601 ELMWOOD AVE-BOX 612 ROCHESTER NY 14642 (716) 275-2644 370 330286 GOOD SAMARITAN HOSPITAL 1000 MONTAUK HIGHWAY WEST ISLIP NY 11795 (516) 661-3000 700 330288 JULIA BUTTERFIELD HOSPITAL PAULDING AVE COLD SPRING NY 10516 (914) 265-3642 580 330290 ST VINCENTS HOSPITAL MEDICAL CENTER 153 W 11TH STREET NEW YORK NY 10011 (212) 790-8112 420 330293 LAKE SHORE HOSPITAL ROUTES 5 AND 20 AT SENECA ROAD IRVING NY 14081 (716) 934-2654 60 330304 WHITE PLAINS HOSPITAL MEDICAL CENTER DAVIS AVE AT EAST POST RD WHITE PLAINS NY 10601 (914) 681-1200 800 330306 LUTHERAN MEDICAL CENTER 150 55 ST BROOKLYN NY 11220 (718) 630-7300 331 330307 CAYUGA MEDICAL CENTER AT ITHACA 101 DATES DRIVE ITHACA NY 14850 (607) 274-4011 730 330308 LITTLE NECK COMMUNITY HOSPITAL 55-15 LITTLE NECK PKW LITTLE NECK NY 11362 (718) 428-3000 590 330314 BRUNSWICK HOSPITAL 366 BROADWAY AMITYVILLE NY 11701 (516) 789-7000 700 330316 NEW YORK WESTCHESTER SQUARE MEDICAL CE 2475 ST RAYMOND AVENUE BRONX NY 10461 (212) 430-7300 20 330331 NORTH SHORE UNIV HOSP AT PLAINVIEW 888 OLD COUNTRY RD PLAINVIEW NY 11803 (516) 681-8900 400 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 92 Provider ID Hospital Name Address City State ZIP Telephone County 330332 NEW ISLAND HOSPITAL 4295 HEMPSTEAD TPKE BETHPAGE NY 11714 (516) 579-6000 400 330333 ISLAND MEDICAL CENTER 820 FRONT ST HEMPSTEAD NY 11550 (516) 560-1215 400 330338 ST AGNES HOSPITAL 305 NORTH ST WHITE PLAINS NY 10605 (914) 681-4500 800 330339 BELLEVUE MATERNITY HOSPITAL INC 2210 TROY RD SCHENECTADY NY 12301 (518) 346-9400 650 330340 SOUTHAMPTON HOSPITAL 240 MEETING HOUSE LANE SOUTHAMPTON NY 11968 (516) 726-8300 700 330350 UNIVERSITY HOSPITAL OF BROOKLYN 445 LENOX RD BROOKLYN NY 11203 (718) 270-2401 331 330353 NORTH SHORE UNIV HOSP AT FOREST HILLS 102-01 66TH RD FOREST HILLS NY 11375 (212) 630-8605 590 330354 ROSWELL CANCER INSTITUTE 666 ELM ST BUFFALO NY 14203 (716) 845-2300 60 330357 CATHOLIC MED CTR OF BROOKLYN/QUEENS 88-25 153RD ST JAMAICA NY 11432 (718) 657-6800 590 330372 FRANKLIN GENERAL HOSPITAL 900 FRANKLIN AVE VALLEY STREAM NY 11580 (516) 825-8800 400 330385 NORTH CENTRAL BRONX HOSPITAL 3424 KOSSUTH AVE BRONX NY 10467 (212) 519-5000 20 330386 CATSKILL REGIONAL MEDICAL CENTER 68 HARRIS BUSHVILLE ROAD PO BOX 800 HARRIS NY 12742 (845) 794-3300 710 330387 ROCKEFELLER UNIVERSITY HOSPITAL 1230 YORK AVE NEW YORK NY 10021 (212) 570-8000 420 330389 ORTHOPAEDIC INSTITUTE 301 E 17TH ST NEW YORK NY 10003 (212) 598-6000 420 330390 NORTH GENERAL HOSPITAL 1879 MADISON AVE NEW YORK NY 10035 (212) 650-4000 420 330393 UNIVERSITY HOSPITAL SUNY AT STONY BROOK SUNY STONY BROOK NY 11794 (516) 444-2701 700 330394 UNITED HEALTH SERVICES PO BOX 540 JOHNSON CITY NY 13790 (607) 763-6130 30 330395 ST JOHNS ESPISCOPAL HOSPITAL 393 FRONT STREET HEMPSTEAD NY 11550 (516) 560-6400 400 330396 WOODHULL MEDICAL/MENTAL HLTH CENTER 760 BROADWAY BROOKLYN NY 11206 (718) 963-8100 331 330397 INTERFAITH MEDICAL CENTER 1545 ATLANTIC AVE BROOKLYN NY 11213 (718) 935-7070 331 330399 ST BARNABAS HOSPITAL 4422 THIRD AVE BRONX NY 10457 (212) 960-6400 20 330401 ST CATHERINE OF SIENA MEDICAL CENTER 50 ROUTE 25A SMITHTOWN NY 11787 (631) 862-3100 700 330402 WESTCHESTER ELLENVILLE HOSPITAL INC ROUTE 209 SHOPRITE BLVD ELLENVILLE NY 12428 (845) 647-6400 740 331301 CUBA MEMORIAL HOSPITAL INC 140 WEST MAIN STREET CUBA NY 14727 (716) 961-2000 10 331302 ELIZABETHTOWN COMMUNITY HOSPITAL PARK STREET, PO BOX 277 ELIZABETHTOWN NY 12932 (518) 873-6377 260 331303 CATSKILL REGIONAL MEDICAL CENTER RT 97 CALLICOON NY 12723 (845) 887-5530 710 331304 MARGARETVILLE MEMORIAL HOSPITAL RTE 28 BOX 200 MARGARETVILLE NY 12455 (845) 586-2631 220 331305 O'CONNOR HOSPITAL ANDES ROAD DELHI NY 13753 (607) 746-0300 220 331306 MOSES-LUDINGTON HOSPITAL 2 WICKER STREET TICONDEROGA NY 12883 (518) 585-2831 260 331307 CLIFTON FINE HOSPITAL PO BOX 10, OSWEGATCHIE TRAIL STAR LAKE NY 13690 (315) 848-3351 630 331990 HIGH RIDGE HOUSE 5959 INDEPENDENCE AVENUE BRONX NY 10471 (718) 796-4200 10 332006 CALVARY HOSPITAL INC 1740-1770 EASTCHESTER RD BRONX NY 10461 (718) 863-6900 20 332008 GOLDWATER MEMORIAL HOSP ROOSEVELT ISLAND NEW YORK NY 10044 (212) 750-6800 420 332014 SUMMIT PARK HOSP SANATORIUM ROAD POMONA NY 10970 (914) 364-2700 620 332021 MONROE COM HOSP 435 E HENRIETTA RD ROCHESTER NY 14620 (716) 274-7400 370 332022 TERRENCE CARDINAL COOKE HLTH CARE CTR 1249 FIFTH AVE NEW YORK NY 10029 (212) 360-3600 420 333025 SUNNYVIEW HOSP REHAB CTR 1270 BELMONT AVE SCHENECTADY NY 12308 (518) 382-4500 650 333027 HELEN HAYES HOSP RT 9 WEST WEST HAVERSTRAW NY 10993 (914) 947-3000 620 333028 BURKE REHAB HOSPITAL, THE 785 MAMARONECK AVE WHITE PLAINS NY 10605 (914) 948-0050 800 333029 EDDY COHOES REHABILITATION CENTER 421 COLUMBIA ST COHOES NY 12047 (518) 237-5630 0 333300 CHILDRENS HOSP 219 BRYANT ST BUFFALO NY 14222 (716) 878-7000 240 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 93 Provider ID Hospital Name Address City State ZIP Telephone County 333301 BLYTHDALE CHILDRENS HOSPITAL BRADHURST AVENUE VALHALLA NY 10595 (914) 592-7555 800 334001 RICHARD H HUTCHINGS PSYCHIATRIC CTR 620 MADISON STREET SYRACUSE NY 13210 (315) 473-4980 520 334002 FOUR WINDS CROSS RIVER RD KATONAH NY 10536 (914) 763-8151 800 334003 ST LAWRENCE PSYCH CENTER STATION A OGDENSBURG NY 13669 (315) 393-3000 630 334004 CREEDMOOR PSYCHIATRIC CENTER 80-45 WINCHESTER BLVD BLDG B QUEENS VILLAGE NY 11427 (718) 264-4000 590 334009 NEW YORK STATE PSYCHIATRIC INSTITUTE 722 W 168TH ST NEW YORK NY 10032 (212) 960-2200 420 334010 HUDSON RIVER PSYCHIATRIC CENTER BRANCH B POUGHKEEPSIE NY 12601 (914) 452-8000 230 334012 BINGHAMTON PSYCH CENTER 425 ROBINSON ST BINGHAMTON NY 13901 (607) 724-1391 30 334013 PILGRIM STATE HOSP P O BOX A WEST BRENTWOOD NY 11717 (516) 434-7500 700 334015 ROCKLAND PSYCH CTR 140 OLD ORANGEBURG RD ORANGEBURG NY 10962 (845) 359-1000 620 334017 MIDDLETOWN PSYCH CENTER 122 DOROTHEA DIX DRIVE MIDDLETOWN NY 10940 (914) 342-5511 540 334020 ROCHESTER PSYCHIATRIC CENTER 1600 SOUTH AVE ROCHESTER NY 14620 (716) 473-3230 370 334021 MOHAWK VALLEY PSYCHIATRIC CENTER 1400 NOYES ST UTICA NY 13502 (315) 797-6800 510 334022 BRYLIN HOSP 1263 DELAWARE AVE BUFFALO NY 14209 (716) 886-8200 240 334026 BRUNSWICK PSYCH CENTER 81 LOUDEN AVE AMITYVILLE NY 11701 (516) 789-7000 700 334027 SOUTH OAKS HOSP 400 SUNRISE HIGHWAY AMITYVILLE NY 11701 (516) 264-4000 700 334033 RYE PSYCH HOSP CENTER 754 BOSTON POST RD RYE NY 10580 (914) 967-4567 800 334043 SOUTH BEACH PSYCHIATRIC CENTER 777 SEAVIEW AVE STATEN ISLAND NY 10305 (718) 667-2300 610 334045 ELMIRA PSYCH CENTER WASHINGTON ST ELMIRA NY 14901 (607) 737-4739 70 334046 CAPITAL DISTRICT PSYCH CENTER 75 NEW SCOTLAND AVE ALBANY NY 12208 (845) 398-5566 0 334048 GRACIE SQUARE HOSP 420 EAST 76 ST NEW YORK NY 10021 (212) 988-4400 420 334049 FOUR WINDS 30 CRESCENT AVE SARATOGA SPRINGS NY 12866 (518) 584-3600 640 334052 BUFFALO PSYCHIATRIC CENTER 400 FOREST AVE BUFFALO NY 14213 (716) 885-2261 240 334053 BRONX PSYCHIATRIC CENTER 1500 WATERS PLACE BRONX NY 10461 (718) 931-0600 20 334054 MANHATTAN PSYCHIATRIC CENTER WARD'S ISLAND NEW YORK NY 10035 (212) 369-0500 420 334055 HOLLISWOOD HOSPITAL,THE 87-37 PALERMO STREET HOLLIS NY 11423 (718) 776-8181 590 334058 KINGSBORO PSYCHIATRIC CENTER 681 CLARKSON AVE BROOKLYN NY 11203 (718) 221-7339 331 334059 STONEY LODGE HOSPITAL 40 CROTON DAM ROAD OSSINING NY 10562 (914) 941-7400 800 334060 KIRBY FORENSIC PSYCHIATRIC CENTER WARD ISLAND NEW YORK NY 10035 (212) 427-9003 420 334061 MID HUDSON FORENSIC PSYCHIATRIC CTR BOX 158 ROUTE 17M NEW HAMPTON NY 10958 (845) 374-3171 540 334062 FOUR WINDS SYRACUSE 650 SOUTH SALINA STREET SYR NY 13202 (315) 476-2161 520 340001 NORTHEAST MEDICAL CENTER 920 CHURCH ST N CONCORD NC 28025 (704) 788-5800 120 340002 MEMORIAL MISSION HOSPITAL 509 BILTMORE AVE ASHEVILLE NC 28801 (828) 255-4000 100 340003 NORTHERN HOSPITAL OF SURRY COUNTY 830 ROCKFORD ST MOUNT AIRY NC 27030 (910) 719-7000 850 340004 HIGH POINT REGIONAL HOSPITAL 601 N ELM ST PO BOX HP-5 HIGH POINT NC 27262 (336) 884-6052 400 340005 CANNON MEMORIAL HOSPITAL 434 HOSPITAL DR P O BOX 767 LINVILLE NC 28646 (828) 898-5111 50 340007 ANNIE PENN MEMORIAL HOSPITAL 618 S MAIN ST REIDSVILLE NC 27320 (336) 634-1010 780 340008 SCOTLAND MEMORIAL HOSPITAL 500 LAUCHWOOD DR LAURINBURG NC 28352 (910) 291-7000 820 340010 WAYNE MEMORIAL HOSPITAL 2700 WAYNE MEMORIAL DR GOLDSBORO NC 27530 (919) 736-1110 950 340011 SPRUCE PINE COMMUNITY HOSPITAL 125 HOSPITAL DR SPRUCE PINE NC 28777 (704) 765-4201 600 340012 ANGEL MEDICAL CENTER 120 RIVERVIEW ST PO BOX 1209 FRANKLIN NC 28734 (828) 369-4231 560 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 94 Provider ID Hospital Name Address City State ZIP Telephone County 340013 RUTHERFORD HOSPITAL INC 288 SOUTH RIDGECREST AVE RUTHERFORDTON NC 28139 (828) 286-5000 800 340014 FORSYTH MEMORIAL HOSPITAL 3333 SILAS CREEK PARKWAY WINSTON-SALEM NC 27103 (336) 718-5000 330 340015 ROWAN REGIONAL MEDICAL CENTER 612 MOCKSVILLE AVE SALISBURY NC 28144 (704) 638-1000 790 340016 HARRIS REGIONAL HOSPITAL, INC 68 HOSPITAL RD SYLVA NC 28779 (828) 586-7000 490 340017 MARGARET R PARDEE MEMORIAL HOSPITAL 715 FLEMING ST HENDERSONVILLE NC 28739 (828) 696-1000 440 340018 ST LUKES HOSPITAL 101 HOSPITAL DR COLUMBUS NC 28722 (828) 894-3311 740 340019 STOKES-REYNOLDS MEMORIAL HOSPITAL PO BOX 10 HWY 8 & 89 DANBURY NC 27016 (336) 593-2831 840 340020 CENTRAL CAROLINA HOSPITAL 1135 CARTHAGE ST SANFORD NC 27330 (919) 774-4100 520 340021 CLEVELAND REGIONAL MEDICAL CENTER 201 GROVER ST SHELBY NC 28150 (704) 487-3802 220 340022 BLADEN COUNTY HOSPITAL HWY 701 N PO BOX 398 ELIZABETHTOWN NC 28337 (919) 862-5100 80 340023 PARK RIDGE HOSPITAL NAPLES RD BOX 1569 FLETCHER NC 28732 (704) 681-2110 440 340024 SAMPSON REGIONAL MEDICAL CENTER 607 BEAMAN ST CLINTON NC 28328 (910) 592-8511 810 340025 HAYWOOD REGIONAL MEDICAL CENTER 262 LEROY GEORGE DRIVE CLYDE NC 28721 (704) 456-7311 430 340027 LENOIR MEMORIAL HOSPITAL 100 AIRPORT RD KINSTON NC 28501 (919) 522-7171 530 340028 CAPE FEAR VALLEY MEDICAL CENTER 1638 OWEN DRIVE P O BOX 2000 FAYETTEVILLE NC 28304 (919) 323-6151 250 340030 DUKE UNIVERSITY HOSPITAL PO BOX 3708 DUMC ERWIN RD DURHAM NC 27710 (919) 684-5587 310 340032 GASTON MEMORIAL HOSPITAL 2525 COURT DR GASTONIA NC 28052 (704) 834-2000 350 340035 FIRSTHEALTH RICHMOND MEMORIAL HOSPITAL 925 LONG DR PO BOX 1928 ROCKINGHAM NC 28379 (910) 417-3701 760 340036 FRANKLIN REGIONAL MEDICAL CENTER 100 HOSPITAL DR BOX 609 LOUISBURG NC 27549 (919) 496-5131 340 340037 KINGS MOUNTAIN HOSPITAL INC 706 W KING ST KINGS MOUNTAIN NC 28086 (704) 739-3601 220 340038 BEAUFORT COUNTY HOSPITAL 628 E 12TH ST WASHINGTON NC 27889 (919) 975-4100 60 340039 IREDELL MEMORIAL HOSPITAL INC 557 BROOKDALE DR P O BOX 1828 STATESVILLE NC 28677 (704) 878-4500 480 340040 PITT COUNTY MEMORIAL HOSPITAL 200 STANTONSBURG RD BOX 6028 GREENVILLE NC 27834 (919) 816-4100 730 340041 CALDWELL MEMORIAL HOSPITAL 321 MULBERRY ST SW LENOIR NC 28645 (704) 757-5187 130 340042 ONSLOW MEMORIAL HOSPITAL 317 WESTERN BOULEVARD JACKSONVILLE NC 28540 (910) 577-2281 660 340044 ALLEGHANY COUNTY MEMORIAL HOSPITAL 617 DOCTORS STREET SPARTA NC 28675 (919) 372-5511 20 340045 BLOWING ROCK HOSPITAL CHESTNUT DR BOX 148 BLOWING ROCK NC 28605 (828) 295-3136 940 340047 NORTH CAROLINA BAPTIST HOSPITALS MEDICAL CENTER BOULEVARD WINSTON-SALEM NC 27157 (336) 716-3089 330 340049 NORTH CAROLINA SPECIALTY HOSPITAL 1110 W MAIN ST DURHAM NC 27701 (919) 956-9300 310 340050 SOUTHEASTERN REGIONAL MEDICAL CENTER 300 W 27 ST PO BOX 1408 LUMBERTON NC 28359 (910) 671-5000 770 340051 WATAUGA MEDICAL CENTER PO BOX 2600 BOONE NC 28607 (704) 264-4100 940 340052 DAVIE COUNTY HOSPITAL 222 HOSP ST MOCKSVILLE NC 27028 (704) 751-8100 290 340053 PRESBYTERIAN HOSPITAL 200 HAWTHORNE LANE BOX 33549 CHARLOTTE NC 28233 (704) 384-4000 590 340055 VALDESE GENERAL HOSPITAL INC 720 MALCOLM BLVD VALDESE NC 28690 (704) 874-2251 110 340060 MOREHEAD MEMORIAL HOSPITAL 117 E KINGS HIGHWAY EDEN NC 27288 (919) 623-9711 780 340061 UNIVERSITY OF NORTH CAROLINA HOSPITAL 101 MANNING DRIVE CHAPEL HILL NC 27514 (919) 966-4131 670 340064 WILKES REGIONAL MEDICAL CENTER 1370 WEST D ST NORTH WILKESBORO NC 28659 (336) 651-8100 960 340065 CHOWAN HOSPITAL VIRGINIA RD BOX 629 EDENTON NC 27932 (252) 482-8451 200 340068 COLUMBUS COUNTY HOSPITAL INC 500 JEFFERSON ST WHITEVILLE NC 28472 (910) 642-8011 230 340069 WAKEMED/NEW BERN AVE CAMPUS 3000 NEW BERN AVE RALEIGH NC 27610 (919) 250-8108 910 340070 ALAMANCE REGIONAL MEDICAL CENTER 1240 HUFFMAN MILL RD PO BOX 202 BURLINGTON NC 27216 (919) 229-2600 0 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 95 Provider ID Hospital Name Address City State ZIP Telephone County 340071 BETSY JOHNSON MEMORIAL HOSPITAL 800 TILGHMAN DR DUNN NC 28334 (910) 892-7161 420 340072 ASHE MEMORIAL HOSPITAL 200 HOSPITAL AVE JEFFERSON NC 28640 (919) 246-7101 40 340073 RALEIGH COMMUNITY HOSPITAL 3400 WAKE FOREST RD RALEIGH NC 27609 (919) 954-3000 910 340075 GRACE HOSPITAL INC 2201 S STERLING ST MORGANTON NC 28655 (704) 438-2249 110 340084 ANSON COUNTY HOSPITAL 500 MORVEN ROAD WADESBORO NC 28170 (704) 694-5131 30 340085 THOMASVILLE MEDICAL CENTER 207 OLD LEXINGTON RD BOX 789 THOMASVILLE NC 27360 (336) 472-2000 280 340087 MCDOWELL HOSPITAL,THE 100 RANKIN DRIVE P O BOX 730 MARION NC 28752 (828) 659-5100 550 340088 TRANSYLVANIA COMMUNITY HOSPITAL INC HOSPITAL DR BOX 1116 BREVARD NC 28712 (910) 625-5151 870 340090 JOHNSTON MEMORIAL HOSPITAL PO BOX 1376 509 BRIGHT LEAF BLVD SMITHFIELD NC 27577 (919) 934-8171 500 340091 MOSES H CONE MEMORIAL HOSPITAL,THE 1200 N ELM ST GREENSBORO NC 27401 (910) 574-7881 400 340096 LEXINGTON MEMORIAL HOSPITAL INC 250 HOSPITAL DRIVE PO BOX 1817 LEXINGTON NC 27293 (910) 248-5161 280 340097 HUGH CHATHAM MEMORIAL HOSPITAL 180 PARKWOOD DR ELKIN NC 28621 (336) 527-7000 850 340098 MERCY HOSPITAL INC 2001 VAIL AVE CHARLOTTE NC 28207 (704) 379-5100 590 340099 ROANOKE CHOWAN HOSPITAL 500 S ACADEMY ST AHOSKIE NC 27910 (919) 209-3000 450 340104 CRAWLEY MEMORIAL HOSPITAL 315 W COLLEGE AVE BOX 996 BOILING SPRINGS NC 28017 (704) 434-9466 220 340106 SANDHILLS REGIONAL MEDICAL CENTER 1000 WEST HAMLET AVENUE HAMLET NC 28345 (919) 582-3611 760 340107 HERITAGE HOSPITAL 111 HOSPITAL DR TARBORO NC 27886 (252) 641-7700 320 340109 ALBEMARLE HOSPITAL 1144 N ROAD ST ELIZABETH CITY NC 27909 (252) 331-4600 690 340112 WASHINGTON COUNTY HOSPITAL 958 US HWY 64 EAST PLYMOUTH NC 27962 (919) 793-4135 930 340113 CAROLINAS MEDICAL CENTER/BEHAV HEALTH 1000 BLYTHE BLVD CHARLOTTE NC 28232 (704) 355-2000 590 340114 REX HOSPITAL 4420 LAKE BOONE TRAIL RALEIGH NC 27607 (919) 783-3181 910 340115 FIRSTHEALTH MOORE REGIONAL HOSPITAL 155 MEMORIAL DRIVE PINEHURST NC 28374 (910) 215-1000 620 340116 FRYE REGIONAL MEDICAL CENTER 420 N CENTER ST HICKORY NC 28601 (704) 322-6070 170 340119 STANLY MEMORIAL HOSPITAL INC 301 YADKIN ST BOX 1489 ALBEMARLE NC 28001 (704) 984-4000 830 340120 DUPLIN GENERAL HOSPITAL DUPLIN ST BOX 278 KENANSVILLE NC 28349 (910) 296-0941 300 340121 J ARTHUR DOSHER MEMORIAL HOSPITAL 924 HOWE ST SOUTHPORT NC 28461 (910) 457-5271 90 340123 RANDOLPH HOSPITAL 364 WHITE OAK STREET ASHEBORO NC 27203 (910) 625-5151 750 340124 GOOD HOPE HOSPITAL 410 DENIM DR PO BOX 668 ERWIN NC 28339 (910) 897-6151 420 340126 WILSON MEDICAL CENTER 1705 S TARBORO ST WILSON NC 27893 (252) 399-8040 970 340127 GRANVILLE MEDICAL CENTER COLLEGE ST BOX 947 OXFORD NC 27565 (919) 690-3405 380 340129 LAKE NORMAN REGIONAL MEDICAL CENTER 171 FAIRVIEW ROAD MOORESVILLE NC 28117 (704) 663-1113 480 340130 UNION REGIONAL MEDICAL CENTER 600 HOSPITAL DR BOX 5003 MONROE NC 28110 (704) 283-3100 890 340131 CRAVEN REGIONAL MEDICAL CENTER 2000 NEUSE BLVD NEW BERN NC 28560 (919) 633-8123 240 340132 MARIA PARHAM HOSPITAL PO DRAWER 59 RUIN CREEK RD HENDERSON NC 27536 (252) 438-4142 900 340133 MARTIN GENERAL HOSPITAL 310 S MCCASKEY RD P O BOX 1128 WILLIAMSTON NC 27892 (252) 809-6179 580 340137 BROUGHTON HOSPITAL-MEDICAL UNIT 1000 S STERLING ST MORGANTON NC 28655 (704) 433-2324 110 340138 DOROTHEA DIX HOSPITAL S BOYLAN AVE RALEIGH NC 27603 (919) 733-5324 910 340141 NEW HANOVER REGIONAL MEDICAL CENTER 2131 S 17TH ST BOX 9000 WILMINGTON NC 28402 (910) 343-7000 640 340142 CARTERET GENERAL HOSPITAL 3500 ARENDELL ST MOREHEAD CITY NC 28557 (252) 247-1616 150 340143 CATAWBA VALLEY MEDICAL CENTER 810 FAIRGROVE CHURCH RD HICKORY NC 28602 (704) 326-3000 170 340144 DAVIS REGIONAL MEDICAL CENTER 218 OLD MOCKSBVILLE RD PO BOX 1823 STATESVILLE NC 28687 (704) 838-0881 480 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 96 Provider ID Hospital Name Address City State ZIP Telephone County 340145 LINCOLN MEDICAL CENTER GAMBLE DRIVE PO BOX 677 LINCOLNTON NC 28092 (704) 735-3071 540 340146 HIGHLANDS-CASHIERS HOSPITAL INC HWY 64 EAST PO DRAWER 190 HIGHLANDS NC 28741 (828) 526-1200 160 340147 NASH GENERAL HOSPITAL 2460 CURTIS ELLIS DRIVE ROCKY MOUNT NC 27804 (919) 443-8000 630 340148 MEDICAL PARK HOSPITAL 1950 S HAWTHORNE RD WINSTON-SALEM NC 27103 (910) 768-7680 330 340151 HALIFAX REGIONAL MEDICAL CENTER INC 250 SMITH CHURCH RD ROANOKE RAPIDS NC 27870 (252) 535-8011 410 340153 PRESBYTERIAN-ORTHOPAEDIC HOSPITAL 1901 RANDOLPH RD CHARLOTTE NC 28207 (704) 370-1552 590 340155 DURHAM REGIONAL HOSPITAL 3643 N ROXBORO ST DURHAM NC 27704 (919) 470-4000 310 340156 US PHS INDIAN HOSPITAL CHEROKEE NC 28719 (704) 497-9163 860 340158 BRUNSWICK COMMUNITY HOSPITAL 1 MEDICAL CENTER DR PO BOX 139 SUPPLY NC 28462 (910) 754-8121 90 340159 PERSON COUNTY MEMORIAL HOSPITAL 615 RIDGE RD ROXBORO NC 27573 (336) 599-2121 720 340160 MURPHY MEDICAL CENTER INC 4130 US HIGHWAY 64 EAST MURPHY NC 28906 (704) 837-8161 190 340166 UNIVERSITY MEMORIAL HOSPITAL 8800 NORTH TYRON STREET CHARLOTTE NC 28262 (704) 548-6000 590 340168 WILMINGTON TREATMENT CENTER 2520 TROY DRIVE WILMINGTON NC 28401 (919) 762-2727 640 340170 AMOS COTTAGE REHABILITATION HOSPITAL 3325 SILAS CREEK PARKWAY WINSTON SALEM NC 27103 (910) 765-9916 330 340171 PRESBYTERIAN HOSPITAL MATTHEWS 1500 MATTHEWS TWNSHP PRKWY BOX 3310 MATTHEWS NC 28106 (704) 384-6500 590 340173 WAKEMED FOR WESTERN WAKE MEDICAL CTR 1900 KILDARE FARM ROAD CARY NC 27511 (919) 250-2550 910 340177 OUTER BANKS HOSPITAL INC,THE 4800 S CROATAN HWY NAGS HEAD NC 27959 (252) 449-4500 270 340178 FAYETTEVILLE SPECIALTY HOSPITAL 150 ROBESON STREET 4TH FLOOR FAYETTEVILLE NC 28301 (910) 609-1199 250 341301 YANCEY COMMUNITY MEDICAL CENTER 320 PENSACOLA RD BURNSVILLE NC 28714 (704) 682-6136 981 341302 OUR COMMUNITY HOSPITAL 921 JUNIOR HIGH ROAD SCOTLAND NECK NC 27874 (919) 826-4144 410 341303 FIRSTHEALTH MONTGOMERY MEMORIAL HOSP 520 ALLEN STREET TROY NC 27371 (910) 571-5000 610 341304 BERTIE MEMORIAL HOSPITAL 401 STERLINGWORTH STREET WINDSOR NC 27983 (252) 794-3141 70 341305 SWAIN COUNTY HOSPITAL INC 45 PLATEAU STREET BRYSON CITY NC 28713 (828) 488-4013 860 341307 PENDER MEMORIAL HOSPITAL 507 FREMONT STREET BURGAW NC 28425 (910) 259-5451 700 341308 HOOTS MEMORIAL HOSPITAL INC 624 WEST MAIN ST YADKINVILLE NC 27055 (336) 679-2041 980 341309 DISTRICT MEDICAL CENTER 415 WHITAKER LANE ANDREWS NC 28901 (828) 321-1200 190 341310 PUNGO DISTRICT HOSPITAL 210 EAST WATER ST BELHAVEN NC 27810 (252) 944-2111 60 341311 CHATHAM HOSPITAL INC WEST THIRD ST SILER CITY NC 27344 (373) 663-2113 180 342012 KINDRED HOSPITAL GREENSBORO 2401 SOUTHSIDE BLVD GREENSBORO NC 27406 (336) 271-2800 400 342013 LIFECARE HOSPITALS OF NC 1031 NOELL LANE ROCKY MOUNT NC 27804 (252) 451-2300 630 343025 THOMS REHABILITATION HOSP 68 SWEETEN CREEK RD ASHEVILLE NC 28813 (704) 274-2400 100 343026 CHARLOTTE INSTITUTE OF REHABILITATION 1100 BLYTHE BOULEVARD CHARLOTTE NC 28203 (704) 355-4370 590 344001 DOROTHEA DIX HOSP S BOYLAN AVE RALEIGH NC 27603 (919) 733-5324 910 344002 BROUGHTON HOSP 1000 S STERLING ST MORGANTON NC 28655 (828) 433-2324 110 344003 CHERRY HOSPITAL 201 STEVENS MILL ROAD GOLDSBORO NC 27530 (919) 731-3203 950 344004 JOHN UMSTEAD HOSP 1003 12TH ST BUTNER NC 27509 (919) 575-7229 380 344010 BEHAVORIAL HEALTH OF CAPE FEAR VALLEY 3425 MELROSE RD FAYETTEVILLE NC 28304 (910) 609-3000 250 344011 WAKE CO ALCOHOLISM TREATMENT CTR 3000 FALSTAFF RD RALEIGH NC 27610 (919) 250-1500 910 344014 HOLLY HILL MENTAL HEALTH SERVICES 3019 FALSTAFF RD RALEIGH NC 27610 (919) 250-7000 910 344016 BRYNN MARR HOSP 192 VILLAGE DRIVE JACKSONVILLE NC 28540 (919) 577-1400 660 344023 JULIAN F KEITH ALCOHOL & DRUG ABUSE TX 301 TABERNACLE ROAD BLACK MOUNTAIN NC 28711 (704) 669-3402 100 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 97 Provider ID Hospital Name Address City State ZIP Telephone County 344024 WALTER B JONES ALCOHOL & DRUG ABUSE 2577 WEST FIFTH STREET GREENVILLE NC 27834 (919) 830-3426 730 350002 ST ALEXIUS MEDICAL CENTER 900 E BROADWAY BISMARCK ND 58501 (701) 530-7000 70 350003 ST JOSEPHS HOSPITAL/HEALTH CENTER 30 WEST 7TH ST DICKINSON ND 58601 (701) 456-4277 440 350006 TRINITY ST JOSEPH'S HOSPITAL 407 3RD ST SE & BURDICK EXPRESSWAY MINOT ND 58701 (701) 857-5000 500 350009 JAMESTOWN HOSPITAL 419 5TH STREET N E JAMESTOWN ND 58401 (701) 252-1050 460 350010 HEART OF AMERICA MEDICAL CENTER 802 S MAIN AVE RUGBY ND 58368 (701) 776-5261 340 350011 MERITCARE HOSPITAL 720 4TH ST N FARGO ND 58122 (701) 234-6000 80 350014 TOWNER COUNTY MEDICAL CENTER HWY 281 N BOX 688 CANDO ND 58324 (701) 968-4411 470 350015 MEDCENTER ONE 300 N 7TH ST BISMARCK ND 58506 (701) 323-6000 70 350017 MERCY MEDICAL CENTER 1301 15TH AVE W WILLISTON ND 58801 (701) 774-7400 520 350019 ALTRU HOSPITAL 1200 S COLUMBIA RD GRAND FORKS ND 58201 (701) 780-5000 170 350027 HILLSBORO MEDICAL CENTER HOSPITAL 12 3RD ST SE HILLSBORO ND 58045 (701) 436-4501 480 350030 MERCY HOSPITAL,THE 1031 7TH ST DEVILS LAKE ND 58301 (701) 662-2131 350 350058 LINTON HOSPITAL 518 N BROADWAY LINTON ND 58552 (701) 254-4511 140 350061 WEST RIVER REGIONAL MEDICAL CENTER 1000 HIGHWAY 12 HETTINGER ND 58639 (701) 567-4561 0 350063 PHS INDIAN HOSPITAL BELCOURT ND 58316 (701) 477-6111 390 350064 PHS INDIAN HOSPITAL AT FORT YATES BOX J FORT YATES ND 58538 (701) 854-3831 420 350070 INNOVIS HEALTH 3000 32ND AVE S FARGO ND 58103 (701) 364-8050 80 351300 TIOGA MEDICAL CENTER HOSPITAL - CAH 810 N WELO ST TIOGA ND 58852 (701) 664-3305 520 351301 MOUNTRAIL COUNTY MEDICAL CENTER - CAH 502 3RD STREET SE STANLEY ND 58784 (701) 628-2424 300 351302 MCKENZIE COUNTY MEMORIAL HOSPITAL -CAH 508 N MAIN WATFORD CITY ND 58854 (701) 842-3000 260 351303 GARRISON MEMORIAL HOSPITAL - CAH 407 3RD AVE SE GARRISON ND 58540 (701) 463-2275 270 351304 COMMUNITY MEMORIAL HOSPITAL-CAH 220 5TH AVENUE TURTLE LAKE ND 58575 (701) 448-2331 270 351305 KENMARE COMMUNITY HOSPITAL - CAH 317 1ST AVENUE NW KENMARE ND 58746 (701) 385-4296 500 351306 COOPERSTOWN MEDICAL CENTER - CAH 1200 ROBERTS AVENUE NE COOPERSTOWN ND 58425 (701) 797-2221 190 351307 ST ANDREWS HEALTH CENTER - CAH 316 OHMER STREET BOTTINEAU ND 58318 (701) 228-2255 40 351308 NELSON COUNTY HEALTH SYSTEM - CAH 200 NORTH MAIN MCVILLE ND 58254 (701) 322-4328 310 351309 UNION HOSPITAL-CAH 42 6TH AVENUE SOUTHEAST MAYVILLE ND 58257 (701) 786-3800 480 351310 SAKAKAWEA MEDICAL CENTER - CAH 510 8TH AVENUE NE HAZEN ND 58545 (701) 748-2225 280 351311 LISBON MEDICAL CENTER - CAH 905 MAIN STREET LISBON ND 58054 (701) 683-5241 360 351312 NORTHWOOD DEACONESS HEALTH CENTER-CAH 4 NORTH PARK STREET NORTHWOOD ND 58267 (701) 587-6060 170 351313 SOUTHWEST HEALTHCARE SERVICES - CAH 14 6TH AVENUE SW, DRAWER C BOWMAN ND 58623 (701) 523-5265 50 351314 JACOBSON MEMORIAL HOSP CARE CENTER-CAH 601 EAST STREET NORTH ELGIN ND 58533 (701) 584-2792 180 351315 OAKES COMMUNITY HOSPITAL - CAH 314 S 8TH STREET OAKES ND 58474 (701) 742-3291 180 351316 PRESENTATION MEDICAL CENTER - CAH 213 2ND AVE NE ROLLA ND 58367 (701) 477-3161 390 351317 RICHARDTON HEALTH CENTER - CAH 212 3RD AVE, WEST RICHARDTON ND 58652 (701) 974-3304 440 351318 CARRINGTON HEALTH CENTER - CAH 800 N 4TH STREET CARRINGTON ND 58421 (701) 652-3141 150 351319 PEMBINA COUNTY MEMORIAL HOSPITAL - CAH 301 MOUNTAIN STREET EAST CAVALIER ND 58220 (701) 265-8461 330 351320 UNITY MEDICAL CENTER - CAH 164 WEST 13TH STREET GRAFTON ND 58237 (701) 352-1620 490 351321 WISHEK COMMUNITY HOSPITAL - CAH 1007 4TH AVENUE SOUTH WISHEK ND 58495 (701) 452-2326 250 351322 ASHLEY MEDICAL CENTER - CAH 612 CENTER AVENUE NORTH ASHLEY ND 58413 (701) 288-3433 250 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 98 Provider ID Hospital Name Address City State ZIP Telephone County 351323 CAVALIER COUNTY MEMORIAL HOSPITAL-CAH 909 2ND ST LANGDON ND 58249 (701) 256-6100 90 351324 MERCY HOSPITAL OF VALLEY CITY - CAH 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 (701) 845-6400 10 351325 SAINT LUKES HOSPITAL - CAH 702 1ST ST SW CROSBY ND 58730 (701) 965-6384 110 351326 FIRST CARE HEALTH CENTER - CAH 115 VIVIAN STREET PARK RIVER ND 58270 (701) 284-7500 490 351327 SAINT ALOISIUS MEDICAL CENTER CAH 325 EAST BREWSTER HARVEY ND 58341 (701) 324-4651 510 352004 SCCI HOSPITAL - FARGO 1720 UNIVERSITY DRIVE SOUTH FARGO ND 58103 (701) 241-9099 80 352005 SCCI HOSPITAL - CENTRAL DAKOTAS 1000 18TH STREET NW MANDAN ND 58554 (701) 667-2000 290 354003 NORTH DAKOTA STATE HOSPITAL BOX 476 2605 CIRCLE DRIVE JAMESTOWN ND 58402 (701) 253-3650 460 354004 PRAIRIE PSYCHIATRIC CENTER 510 4TH STREET SOUTH FARGO ND 58103 (701) 476-7200 80 354005 RICHARD P STADTER PSYCHIATRIC CENTER 1451 44TH AVENUE SOUTH GRAND FORKS ND 58201 (701) 775-2500 170 360001 MERCY HOSPITAL ANDERSON 7500 STATE ROAD CINCINNATI OH 45255 (513) 624-4500 310 360002 SAMARITAN REGIONAL HEALTH SYSTEM 1025 CENTER ST ASHLAND OH 44805 (419) 289-0491 20 360003 UNIVERSITY HOSPITAL, INC 234 GOODMAN STREET CINCINNATI OH 45267 (513) 558-4628 310 360006 RIVERSIDE METHODIST HOSPITAL 3535 OLENTANGY RIVER RD COLUMBUS OH 43214 (614) 261-5151 250 360007 RIVER VALLEY HEALTH SYSTEM-IRONTON CPS 2228 S NINTH ST IRONTON OH 45638 (614) 532-3231 450 360008 SOUTHERN OHIO MEDICAL CENTER 1805 27TH STREET PORTSMOUTH OH 45662 (614) 354-7581 740 360009 LIMA MEMORIAL HOSPITAL 1001 BELLEFONTAINE AVENUE LIMA OH 45804 (419) 228-3335 10 360010 UNION HOSPITAL 659 BOULEVARD DOVER OH 44622 (330) 343-3311 800 360011 MARION GENERAL HOSPITAL MCKINLEY PARK DR MARION OH 43302 (614) 383-8400 520 360012 ST ANNS HOSPITAL OF COLUMBUS 500 SOUTH CLEVELAND AVE WESTERVILLE OH 43081 (614) 251-4000 250 360013 WILSON MEMORIAL HOSPITAL 915 WEST MICHIGAN STREET SIDNEY OH 45365 (937) 498-2311 760 360014 O BLENESS MEMORIAL HOSPITAL HOSPITAL DRIVE ATHENS OH 45701 (614) 593-5551 40 360016 JEWISH HOSPITAL, THE 4777 EAST GALBRAITH ROAD CINCINNATI OH 45236 (513) 569-2000 310 360017 GRANT MEDICAL CENTER 111 S GRANT AVE COLUMBUS OH 43215 (614) 461-3232 250 360018 FRANCISCAN MEDICAL CTR-DAYTON CAMPUS ONE FRANCISCAN WAY DAYTON OH 45408 (937) 229-6000 580 360019 BARBERTON CITIZENS HOSPITAL 155 5TH STREET N E BARBERTON OH 44203 (330) 745-1611 780 360020 SUMMA HEALTH SYSTEMS HOSPITALS 525 EAST MARKET STREET AKRON OH 44309 (330) 375-3101 780 360024 FIRELANDS REG MED CTR-SOUTH CAMPUS 1912 SOUTH HAYES AVE SANDUSKY OH 44870 (419) 625-8450 220 360025 FIRELANDS REG MED CTR-MAIN CAMPUS 1101 DECATOR ST SANDUSKY OH 44870 (419) 626-7400 220 360026 GREENE MEMORIAL HOSPITAL 1141 N MONROE DR XENIA OH 45385 (937) 372-8011 290 360027 AKRON GENERAL MEDICAL CTR 400 WABASH AVE AKRON OH 44307 (330) 384-6558 780 360029 WOOD COUNTY HOSPITAL 950 W WOOSTER ST BOWLING GREEN OH 43402 (419) 354-8900 880 360030 BUCYRUS COMMUNITY HOSPITAL 629 NORTH SANDUSKY AVENUE BUCYRUS OH 44820 (419) 562-4677 160 360032 JOINT TOWNSHIP DISTRICT MEMORIAL HOSP 200 SAINT CLAIR STREET SAINT MARYS OH 45885 (419) 394-3335 50 360034 DUNLAP MEMORIAL HOSPITAL 832 SOUTH MAIN STREET ORRVILLE OH 44667 (330) 682-3010 860 360035 MT CARMEL HEALTH 793 W STATE ST COLUMBUS OH 43222 (614) 234-5423 250 360036 WOOSTER COMMUNITY HOSPITAL 1761 BEALL AVE WOOSTER OH 44691 (216) 263-8100 860 360037 ST VINCENT CHARITY HOSPITAL 2351 E 22ND ST CLEVELAND OH 44115 (216) 363-2710 170 360038 DEACONESS HOSPITAL 311 STRAIGHT STREET CINCINNATI OH 45219 (513) 559-2100 310 360039 GENESIS HEALTHCARE SYSTEM 2951 MAPLE AVENUE ZANESVILLE OH 43701 (740) 454-5000 610 360040 KNOX COMMUNITY HOSPITAL 1330 COSHOCTON ROAD MOUNT VERNON OH 43050 (740) 393-9000 430 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 99 Provider ID Hospital Name Address City State ZIP Telephone County 360041 PARMA COMMUNITY GENERAL HOSPITAL 7007 POWERS BOULEVARD PARMA OH 44129 (440) 888-1800 170 360044 WAYNE HOSPITAL 835 SWEITZER STREET GREENVILLE OH 45331 (937) 548-1141 190 360046 MCCULLOUGH-HYDE MEMORIAL HOSPITAL 110 NORTH POPLAR STREET OXFORD OH 45056 (513) 524-5612 80 360047 PIKE COUNTY HOSPITAL DAWN LANE WAVERLY OH 45690 (614) 947-2186 670 360048 MEDICAL COLLEGE OF OHIO AT TOLEDO 3000 ARLINGTON AVE TOLEDO OH 43699 (419) 381-4172 490 360049 UNIV HOSP HEALTH SYS ST MICHAEL HOSP 5163 BROADWAY CLEVELAND OH 44127 (216) 429-8000 170 360051 MIAMI VALLEY HOSPITAL ONE WYOMING STREET DAYTON OH 45409 (937) 223-6192 580 360052 GOOD SAMARITAN HOSPITAL 2222 PHILADELPHIA DR DAYTON OH 45406 (513) 278-2612 580 360054 HOLZER MEDICAL CENTER 100 JACKSON PIKE GALLIPOLIS OH 45631 (740) 446-5000 270 360055 TRUMBULL MEMORIAL HOSPITAL 1350 EAST MARKET STREET WARREN OH 44482 (330) 841-9117 790 360056 MERCY HOSPITAL HAMILTON-FAIRFI 3000 MACK ROAD FAIRFIELD OH 45014 (513) 867-6400 80 360058 MERCER CO JOINT TOWNSHIP COMM HOSP 800 WEST MAIN STREET COLDWATER OH 45828 (419) 678-4843 550 360059 METRO HEALTH MEDICAL CENTER 2500 METROHEALTH DRIVE CLEVELAND OH 44109 (216) 778-7800 170 360062 OSUHE 1492 EAST BROAD STREET COLUMBUS OH 43205 (614) 251-3033 250 360064 ST ELIZABETH HEALTH CENTER 1044 BELMONT AVE YOUNGSTOWN OH 44501 (330) 480-2202 510 360065 FISHER TITUS MEMORIAL HOSPITAL 272 BENEDICT AVE NORWALK OH 44857 (419) 668-8101 400 360066 ST RITA'S MEDICAL CENTER 730 WEST MARKET STREET LIMA OH 45801 (419) 227-3361 10 360068 TOLEDO HOSPITAL 2142 NORTH COVE BOULEVARD TOLEDO OH 43606 (419) 471-4245 490 360069 FULTON COUNTY HEALTH CENTER 725 S SHOOP AVE WAUSEON OH 43567 (419) 335-2015 260 360070 MERCY MEDICAL CENTER 1320 MERCY DRIVE NW CANTON OH 44708 (330) 489-1079 770 360071 VAN WERT COUNTY HOSPITAL 1250 S WASHINGTON STREET VAN WERT OH 45891 (419) 238-2390 820 360072 FAIRFIELD MEDICAL CENTER 401 N EWING ST LANCASTER OH 43130 (614) 687-8000 230 360074 FLOWER HOSPITAL 5200 HARROUN RD SYLVANIA OH 43560 (419) 885-1444 490 360075 UHHS RICHMOND HEIGHTS HOSPITAL 27100 CHARDON ROAD RICHMOND HEIGHTS OH 44143 (440) 585-6500 170 360076 MIDDLETOWN REGIONAL HOSPITAL 105 MCKNIGHT DRIVE MIDDLETOWN OH 45042 (513) 424-2111 80 360077 FAIRVIEW HOSPITAL 18101 LORAIN AVE CLEVELAND OH 44111 (216) 476-7000 170 360078 ROBINSON MEMORIAL HOSPITAL 6847 N CHESTNUT RAVENNA OH 44266 (330) 297-0811 680 360079 KETTERING MEDICAL CENTER 3535 SOUTHERN BOULEVARD KETTERING OH 45429 (513) 298-4331 580 360080 EAST OHIO REGIONAL HOSPITAL 90 NORTH 4TH ST MARTINS FERRY OH 43935 (614) 633-1100 60 360081 ST CHARLES MERCY HOSPITAL 2600 NAVARRE AVE OREGON OH 43616 (419) 698-7200 490 360082 MERIDIA EUCLID HOSPITAL 18901 LAKE SHORE BOULEVARD EUCLID OH 44119 (216) 531-9000 170 360084 AULTMAN HOSPITAL 2600 SIXTH STREET SW CANTON OH 44710 (330) 452-9911 770 360085 OHIO STATE UNIVERSITY HOSPITAL 410 W 10TH AVE COLUMBUS OH 43210 (614) 293-5000 250 360086 MERCY MEDICAL CENTER OF SPRINGFIELD 1343 FOUNTAIN BOULEVARD SPRINGFIELD OH 45501 (937) 390-5000 110 360087 LUTHERAN HOSPITAL 1730 WEST 25TH STREET CLEVELAND OH 44113 (216) 696-4300 170 360089 MERCY HOSPITAL 485 W MARKET ST TIFFIN OH 44883 (419) 447-3130 750 360090 ST LUKES HOSPITAL 5901 MONCLOVA RD MAUMEE OH 43537 (419) 893-5911 490 360091 MEDINA GENERAL HOSPITAL 1000 E WASHINGTON ST MEDINA OH 44256 (330) 725-1000 530 360092 MEMORIAL HOSPITAL OF UNION COUNTY 500 LONDON AVE MARYSVILLE OH 43040 (513) 644-6115 810 360093 DEFIANCE REGIONAL MEDICAL CENTER 1200 RALSTON AVENUE DEFIANCE OH 43512 (419) 782-6955 200 360094 RIVERSIDE MERCY HOSPITAL 1600 SUPERIOR STREET TOLEDO OH 43604 (419) 729-6000 490 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 100 Provider ID Hospital Name Address City State ZIP Telephone County 360095 BLANCHARD VALLEY REGIONAL HEALTH CTR 145 W WALLACE FINDLAY OH 45840 (419) 423-5201 330 360096 EAST LIVERPOOL CITY HOSPITAL 425 W 5TH STREET EAST LIVERPOOL OH 43920 (330) 386-2087 140 360098 LAKE HOSPITAL SYSTEM INC 10 EAST WASHINGTON ST PAINESVILLE OH 44077 (440) 354-2400 440 360099 FOSTORIA CITY HOSPITAL 501 VAN BUREN ST FOSTORIA OH 44830 (419) 435-7734 750 360100 MASSILLON COMMUNITY HOSPITAL 875 EIGHTH STREET NE MASSILLON OH 44646 (330) 832-8761 770 360101 HURON HOSPITAL 13951 TERRACE RD CLEVELAND OH 44112 (216) 761-3300 170 360102 DEACONESS HOSPITAL 4229 PEARL RD CLEVELAND OH 44109 (216) 459-6300 170 360106 HOCKING VALLEY COMMUNITY HOSPITAL STATE ROUTE 664N BOX966 LOGAN OH 43138 (740) 380-8214 380 360107 BELLEVUE HOSPITAL 811 NORTHWEST ST BELLEVUE OH 44811 (419) 483-4040 400 360108 MORROW CO HOSPITAL HOME HEALTH 651 W MARION RD MOUNT GILEAD OH 43338 (419) 946-5015 600 360109 COSHOCTON COUNTY MEMORIAL HOSPITAL 1460 ORANGE STREET COSHOCTON OH 43812 (614) 622-6411 150 360112 ST VINCENTS MERCY MEDICAL CENTER 2213 CHERRY ST TOLEDO OH 43608 (419) 251-3368 490 360113 MERCY FRANCISCAN HOSP WESTERN HILLS 3131 QUEEN CITY AVE CINCINNATI OH 45238 (513) 389-5000 310 360114 H B MAGRUDER MEMORIAL HOSPITAL 615 FULTON ST PORT CLINTON OH 43452 (419) 734-3131 630 360115 COMMUNITY HOSPITAL OF BEDFORD 44 BLAINE ST BEDFORD OH 44146 (216) 439-2000 170 360116 BROWN COUNTY HOSPITAL 425 HOME STREET GEORGETOWN OH 45121 (513) 378-6121 70 360118 MEDCENTRAL HEALTH SYSTEM 335 GLESSNER AVE MANSFIELD OH 44903 (419) 526-8000 710 360121 COMMUNITY HOSPITAL 426 CENTRAL DR BRYAN OH 43506 (419) 636-1131 870 360123 COLUMBIA ST JOHN WEST SHORE HOSPITAL 29000 CENTER RIDGE WESTLAKE OH 44145 (216) 331-2500 170 360125 ASHTABULA COUNTY MEDICAL CENTER 2420 LAKE AVE ASHTABULA OH 44004 (440) 997-2262 30 360128 WYANDOT MEMORIAL HOSPITAL 885 N SANDUSKY AVE UPPER SANDUSKY OH 43351 (419) 294-4991 890 360129 ADAMS COUNTY HOSPITAL 210 NORTH WILSON DRIVE WEST UNION OH 45693 (513) 544-5571 0 360130 AMHERST HOSPITAL 254 CLEVELAND AVE AMHERST OH 44001 (440) 988-6000 480 360131 ALLIANCE COMMUNITY HOSPITAL 264 EAST RICE STREET ALLIANCE OH 44601 (330) 829-4000 770 360132 FORT HAMILTON HUGHES MEMORIAL HOSPITAL 630 EATON AVENUE HAMILTON OH 45013 (513) 867-2000 80 360133 GRANDVIEW HOSPITAL & MEDICAL C 405 GRAND AVE DAYTON OH 45405 (937) 226-3200 580 360134 GOOD SAMARITAN HOSPITAL 375 DIXMYTH AVE CINCINNATI OH 45220 (513) 872-2601 310 360137 UNIVERSITY HOSPITALS OF CLEVELAND 11100 EUCLID AVENUE CLEVELAND OH 44106 (216) 844-1000 170 360141 WESTERN RESERVE CARE SYSTEM 500 GYPSY LANE YOUNGSTOWN OH 44501 (330) 747-0777 510 360142 HIGHLAND DISTRICT HOSPITAL 1275 N HIGH ST HILLSBORO OH 45133 (513) 393-6100 370 360143 MARYMOUNT HOSPITAL 12300 MCCRACKEN ROAD GARFIELD HEIGHTS OH 44125 (216) 581-0500 170 360144 MERIDIA SOUTH POINTE HOSPITAL 4110 WARRENSVILLE CENTER ROAD WARRENSVILLE HEIGHTOH 44122 (216) 491-6000 170 360145 EMH REGIONAL MEDICAL CENTER 630 EAST RIVER STREET ELYRIA OH 44035 (216) 329-7500 480 360147 MARIETTA MEMORIAL HOSPITAL 401 MATTHEW STREET MARIETTA OH 45750 (740) 374-1400 850 360148 JOEL POMERENE MEMORIAL HOSPITAL 981 WOOSTER ROAD MILLERSBURG OH 44654 (330) 674-1015 390 360150 CUYAHOGA FALLS GENERAL HOSPITAL 1900 23RD ST CUYAHOGA FALLS OH 44223 (330) 971-7000 780 360151 DOCTORS HOSPITAL OF STARK COUNTY 400 AUSTIN AVENUE NW MASSILLON OH 44646 (330) 837-7217 770 360152 DOCTORS HOSPITAL OHIO HEALTH 1087 DENNISON AVE COLUMBUS OH 43201 (614) 297-4000 250 360153 BELMONT COMMUNITY HOSPITAL 4697 HARRISON STREET BELLAIRE OH 43906 (740) 671-1200 60 360154 BARNESVILLE HOSPITAL ASSOCIATION 639 WEST MAIN STREET, PO BOX 309 BARNESVILLE OH 43713 (614) 425-5101 60 360155 SOUTHWEST GENERAL HEALTH CENTER 18697 BAGLEY RD MIDDLEBURG HEIGHTS OH 44130 (440) 816-8000 170 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 101 Provider ID Hospital Name Address City State ZIP Telephone County 360156 MEMORIAL HOSPITAL 715 SOUTH TAFT AVENUE FREMONT OH 43420 (419) 332-7321 730 360159 ADENA REGIONAL MEDICAL CENTER 272 HOSPITAL RD CHILLICOTHE OH 45601 (614) 772-7582 720 360161 ST JOSEPH HEALTH CENTER 667 EASTLAND AVE SE WARREN OH 44481 (330) 841-4000 790 360163 CHRIST HOSPITAL 2139 AUBURN AVENUE CINCINNATI OH 45219 (513) 585-2934 310 360170 BERGER HOSPITAL 600 NORTH PICKAWAY STREET CIRCLEVILLE OH 43113 (614) 477-9230 660 360172 COMMUNITY HEALTH PARTNERS OF OH-WEST 3700 KOLBE ROAD LORAIN OH 44053 (216) 960-4070 480 360174 UPPER VALLEY MEDICAL CENTER 3130 NORTH DIXIE HIGHWAY TROY OH 45373 (937) 440-4000 560 360175 CLINTON MEMORIAL HOSPITAL 610 WEST MAIN STREET WILMINGTON OH 45177 (937) 382-6611 130 360176 HARDIN MEMORIAL HOSPITAL 921 E FRANKLIN STREET KENTON OH 43326 (419) 673-0761 340 360177 FAYETTE COUNTY MEMORIAL HOSPITAL 1430 COLUMBUS RD WASHINGTON COURT HOH 43160 (614) 335-1210 240 360178 SELBY GENERAL HOSPITAL 1106 COLEGATE DRIVE MARIETTA OH 45750 (614) 373-0582 850 360179 BETHESDA NORTH HOSPITAL 10500 MONTGOMERY ROAD CINCINNATI OH 45242 (513) 745-1111 310 360180 CLEVELAND CLINIC FOUNDATION 9500 EUCLID AVE CLEVELAND OH 44106 (216) 444-2200 170 360185 SALEM COMMUNITY HOSPITAL 1995 EAST STATE STREET SALEM OH 44460 (216) 332-1551 140 360187 COMMUNITY HOSPITAL OF SPRINGFIELD 2615 EAST HIGH STREET SPRINGFIELD OH 45501 (513) 325-0531 110 360189 MADISON COUNTY HOSPITAL INC 210 NORTH MAIN STREET LONDON OH 43140 (614) 852-1372 500 360192 UNIV HOSP HLTH SYSTEM GEAUGA REG HOSP 13207 RAVENNA RD CHARDON OH 44024 (440) 269-6000 280 360194 GALION COMMUNITY HOSPITAL 269 PORTLAND WAY SOUTH GALION OH 44833 (419) 468-4841 160 360195 WADSWORTH RITTMAN HOSPITAL 195 WADSWORTH ROAD WADSWORTH OH 44281 (330) 334-1504 530 360197 MARY RUTAN HOSPITAL 205 PALMER AVENUE BELLEFONTAINE OH 43311 (513) 592-4015 470 360203 SOUTHEASTERN OHIO REGIONAL MEDICAL CTR 1341 NORTH CLARK STREET CAMBRIDGE OH 43725 (740) 439-3561 300 360210 GRADY MEMORIAL HOSPITAL 561 W CENTRAL AVE DELAWARE OH 43015 (614) 369-8711 210 360211 TRINITY HEALTH SYSTEM 380 SUMMIT AVENUE STEUBENVILLE OH 43952 (740) 283-7212 420 360212 LAKEWOOD HOSPITAL 14519 DETROIT AVE LAKEWOOD OH 44107 (216) 521-4200 170 360218 LICKING MEMORIAL HOSPITAL 1320 W MAIN ST NEWARK OH 43055 (614) 344-0331 460 360230 MERIDIA HILLCREST HOSPITAL 6780 MAYFIELD RD MAYFIELD HEIGHTS OH 44124 (216) 449-4500 170 360234 MERCY FRANCISCAN HOSPITAL - MT AIRY 2446 KIPLING AVENUE CINCINNATI OH 45239 (513) 853-5000 310 360236 CLERMONT MERCY HOSPITAL 3000 HOSPITAL DRIVE BATAVIA OH 45103 (513) 732-8278 120 360239 SYCAMORE HOSPITAL 2150 LEITER ROAD MIAMISBURG OH 45342 (513) 866-0551 580 360241 EDWIN SHAW HOSPITAL 1621 FLICKINGER ROAD AKRON OH 44312 (216) 784-1271 780 360242 JAMES CANCER HOSP AND SOLOVE RSCH INST 300 W TENTH AVE COLUMBUS OH 43210 (614) 293-5485 250 360245 GLENBEIGH HEALTH SOURCES 2863 STATE ROUTE 45 P O BOX 298 ROCK CREEK OH 44084 (216) 563-3400 30 360247 PARKSIDE BEHAVIORAL HEALTHCARE INC 349 OLDE RIDENOUR RD COLUMBUS OH 43230 (614) 471-2552 250 360253 DAYTON HEART HOSPITAL 707 EDWIN C MOSES BLVD DAYTON OH 45408 (937) 221-8000 580 360257 HOLZER MEDICAL CENTER-JACKSON 500 BURLINGTON ROAD JACKSON OH 45640 (740) 288-4625 410 360258 BARIATRIC CARE CENTER OF OHIO 3964 HAMILTON SQUARE BLVD GROVEPORT OH 43125 (614) 834-6800 250 360259 BAY PARK COMMUNITY HOSPITAL 2801 BAY PARK DRIVE OREGON OH 43616 (419) 690-8750 490 360260 REGENCY HOSPITAL OF AKRON 155 FIFTH STREET, NE BARBERTON OH 44203 (330) 861-2065 780 360261 THREE GABLES SURGERY CENTER, LLC 5897 SR 7 PROCTORVILLE OH 45669 (740) 886-9911 450 360262 ST ANNE MERCY HOSPITAL 3404 SYLVANIA AVENUE TOLEDO OH 43623 (419) 407-2663 490 361300 PAULDING COUNTY HOSPITAL 11558 SR 111 PAULDING OH 45879 (419) 399-4080 640 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 102 Provider ID Hospital Name Address City State ZIP Telephone County 361301 COMMUNITY MEMORIAL HOSPITAL 208 N COLUMBUS ST HICKSVILLE OH 43526 (419) 542-6692 200 361302 TWIN CITY HOSPITAL 819 NORTH FIRST STREET DENNISON OH 44621 (740) 922-2800 800 361303 LODI COMMUNITY HOSPITAL 225 ELYRIA STREET LODI OH 44254 (330) 948-1222 530 361304 GREENFIELD AREA MEDICAL CENTER 550 MIRABEAU ST GREENFIELD OH 45123 (937) 981-9400 370 361305 DOCTORS HOSPITAL OF NELSONVILLE 1950 MT ST MARYS DR NELSONVILLE OH 45764 (740) 753-1931 40 361306 ALLEN MEDICAL CENTER 200 W LORAIN STREET OBERLIN OH 44074 (440) 775-1211 480 361307 UHHS MEMORIAL HOSPITAL OF GENEVA 870 WEST MAIN STREET GENEVA OH 44041 (440) 466-1141 30 361308 UHHS BROWN MEMORIAL HOSPITAL 158 MAIN ROAD CONNEAUT OH 44030 (440) 593-1131 30 361309 HENRY COUNTY HOSPITAL, INC 11600 STATE ROUTE 424 NAPOLEON OH 43545 (419) 591-3844 360 361310 MERCY HOSPITAL OF WILLARD 110 E HOWARD STREET WILLARD OH 44890 (419) 964-5000 400 361311 HARRISON COMMUNITY HOSPITAL 951 EAST MARKET STREET CADIZ OH 43907 (740) 942-4631 350 361312 MERCY MEMORIAL HOSPITAL 904 SCIOTO AVENUE URBANA OH 43078 (937) 653-5231 100 361990 OVERLOOK HOUSE 2187 OVERLOOK ROAD CLEVELAND OH 44106 (216) 795-3550 0 361991 GLENMONT 4599 AVERY ROAD HILLIARD OH 43026 (614) 876-0084 250 362004 DRAKE CENTER INC 151 GALBRAITH ROAD CINCINNATI OH 45216 (513) 948-2500 310 362007 ST FRANCIS HEALTH CARE CENTRE 401 N BROADWAY GREEN SPRINGS OH 44836 (419) 639-2626 730 362014 REHABILITATION HOSPITAL AT HEATHER HIL 12340 BASS LAKE RD CHARDON OH 44024 (440) 951-5445 280 362015 GRACE HOSPITAL 2307 W 14TH ST CLEVELAND OH 44113 (216) 687-1500 170 362016 SELECT SPECIALTY HOSPITAL-AKRON 400 WABASH AVENUE, FLOOR 9100 AKRON OH 44307 (330) 848-7804 780 362017 SELECT SPECIALTY HOSP-COLUMBUS/UNIV 410 W 10TH AVE, 11TH FL, DOAN HALL COLUMBUS OH 43210 (614) 293-6931 250 362018 SELECT SPECIALTY HOSPITAL-COLUMBUS 1492 E BROAD ST, 8TH FLOOR TOWER COLUMBUS OH 43205 (614) 252-4440 250 362019 SELECT SPECIALTY HOSPITAL-CINC 375 DIXMYTH AVE CINCINNATI OH 45220 (513) 569-6749 310 362020 SCCI HOSPITAL LIMA 730 W MARKET ST LIMA OH 45801 (419) 224-1888 10 362021 SCCI HOSPITAL - MANSFIELD 335 GLESSNER AVE MANSFIELD OH 44903 (419) 526-0777 710 362022 SELECT SPECIALTY HOSPITAL-COL/ 111 SOUTH GRANT AVENUE, 5TH FLOOR COLUMBUS OH 43215 (614) 252-4440 250 362023 SPECIALTY HOSPITAL OF MAHONING VALLEY 345 OAK HILL AVE, SUITE 210 YOUNGSTOWN OH 44502 (330) 480-1289 510 362024 SELECT SPECIALTY HOSPITAL - YOUNGSTOWN 1044 BELMONT AVE YOUNGSTOWN OH 44501 (330) 480-2349 510 362025 SPECIALTY HOSPITAL OF LORAIN 205 W 20TH ST, SUITE 200 LORAIN OH 44052 (440) 960-4000 480 362026 KINDRED HOSPITAL - CLEVELAND 2351 E 22ND ST, 7TH FL CLEVELAND OH 44115 (972) 398-6907 170 362027 SEMPERCARE HOSPITAL OF AKRON INC 525 E MARKET ST AKRON OH 44309 (330) 375-4112 780 362028 LIFE CARE HOSPITAL OF DAYTON 2150 LEITER ROAD MIAMISBURG OH 45342 (937) 384-8300 580 363026 HILLSIDE REHABILITATION HOSPIT 8747 SQUIRES LANE NE WARREN OH 44484 (330) 841-3700 790 363032 GREENBRIAR HOSPITAL FOR SPECIAL SERVS 8064 SOUTH AVENUE-SUITE ONE BOARDMAN OH 44512 (330) 965-6432 510 363300 CHILDREN'S HOSPITAL MEDICAL CENTER 3333 BURNET AVE CINCINNATI OH 45229 (513) 636-4200 310 363301 CONVALESCENT HOSPITAL FOR CHILDREN ELLAND AND BETHUDE AVENUES CINCINNATI OH 45229 (513) 559-4400 310 363302 RAINBOW BABIES AND CHILDRENS HOSP UOC 11100 EUCLID AVENUE CLEVELAND OH 44106 (216) 844-1000 170 363303 CHILDRENS HOSPITAL MED CTR 1 PERKINS SQUARE AKRON OH 44308 (216) 379-8200 780 363304 CLEV CLINIC CHILDREN'S HOSP FO 2801 MARTIN LUTHER KING, JR DRIVE CLEVELAND OH 44104 (216) 721-5400 170 363305 CHILDRENS HOSPITAL 700 CHILDRENS DRIVE COLUMBUS OH 43205 (614) 722-5950 250 363306 CHILDRENS MEDICAL CENTER ONE CHILDRENS PLAZA DAYTON OH 45404 (513) 226-8338 580 363307 TOD CHILDRENS HOSPITAL 500 GYPSY LANE YOUNGSTOWN OH 44501 (330) 740-3898 510 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 103 Provider ID Hospital Name Address City State ZIP Telephone County 364003 HARDING HOSP 445 E GRANVILLE RD WORTHINGTON OH 43085 (614) 885-5381 250 364007 TWIN VALLEY PSYCH SYSTM-COLUMBUS CPS 2200 W BROAD ST COLUMBUS OH 43223 (614) 752-0333 250 364011 NBHS-NORTHFIELD CAMPUS 1756 SAGAMORE RD, P O BOX 305 NORTHFIELD OH 44067 (330) 467-7131 780 364014 NORTHCOAST BEHAVIORAL HC-TOL 930 S DETROIT AVE TOLEDO OH 43614 (419) 381-1881 490 364015 ATHENS CAMPUS 100 HOSPITAL DR ATHENS OH 45701 (614) 594-5000 40 364017 WINDSOR HOSPITAL 115 EAST SUMMIT AVENUE CHAGRIN FALLS OH 44022 (404) 247-5300 170 364023 TWIN VALLEY PSYCH SYSTM-DAYTON CPS 2611 WAYNE AVENUE DAYTON OH 45420 (937) 258-6210 580 364026 RICHLAND HOSPITAL 1451 LUCAS RD MANSFIELD OH 44901 (419) 589-5511 710 364027 CAMBRIDGE CAMPUS 66737 OLD TWENTY-ONE ROAD CAMBRIDGE OH 43725 (614) 439-1371 300 364029 LAURELWOOD HOSPITAL 35900 EUCLID AVE WILLOUGHBY OH 44094 (440) 953-3000 440 364031 HEARTLAND BEHAVIORAL HEALTHCARE 3000 ERIE SW, PO BOX 540 MASSILLON OH 44648 (330) 833-3135 770 364035 PAULINE WARFIELD LEWIS CENTER 1101 SUMMIT RD CINCINNATI OH 45237 (513) 948-3600 310 364036 FOCUS HEALTH CARE OF OHIO 1725 TIMBER LINE RD MAUMEE OH 43537 (419) 891-9333 490 364037 FOX RUN HOSPITAL 67670 TRACO DRIVE ST CLAIRSVILLE OH 43950 (614) 695-2131 60 364038 BELMONT PINES HOSPITAL 615 CHURCHILL-HUBBARD RD YOUNGSTOWN OH 44505 (330) 759-2700 790 364040 MENTAL HEALTH SERVICES-CLARK COUNTY 1345 FOUNTAIN BOULEVARD SPRINGFIELD OH 45504 (937) 399-9500 110 370001 HILLCREST MEDICAL CENTER 1120 SOUTH UTICA AVENUE TULSA OK 74104 (918) 579-1000 710 370002 WOODWARD HOSPITAL AND HEALTH CENTER 900 17TH STREET WOODWARD OK 73801 (580) 256-5511 760 370004 INTEGRIS BAPTIST REG HEALTH CENTER 200 SECOND AVENUE SOUTHWEST, BOX 120MIAMI OK 74355 (918) 542-6611 570 370006 VIA CHRISTI OKLA REG MEDICAL CENTER 1900 NORTH 14TH STREET PONCA CITY OK 74602 (405) 765-3321 350 370007 NEWMAN MEMORIAL HOSPITAL 905 SOUTH MAIN STREET SHATTUCK OK 73858 (405) 938-2551 220 370008 NORMAN REGIONAL HOSPITAL 901 NORTH PORTER, P O BOX 1308 NORMAN OK 73070 (405) 321-1700 130 370011 PARK VIEW HOSPITAL 2115 PARK VIEW DRIVE EL RENO OK 73036 (405) 262-2640 80 370013 MERCY HEALTH CENTER, INC 4300 WEST MEMORIAL ROAD OKLAHOMA CITY OK 73120 (405) 755-1515 540 370014 MEDICAL CTR OF SOUTHEASTERN OKLAHOMA 1800 UNIVERSITY BLVD, P O BOX 1207 DURANT OK 74702 (405) 924-3080 60 370015 INTEGRIS MAYES COUNTY MEDICAL CENTER 129 NORTH KENTUCKY AVENUE, P O BOX 27 PRYOR OK 74362 (918) 825-1600 480 370016 INTEGRIS BASS BAPTIST HEALTH CENTER 600 SOUTH MONROE ENID OK 73701 (405) 233-2300 230 370018 JANE PHILLIPS MEMORIAL MEDICAL CENTER 3500 EAST FRANK PHILLIPS BOULEVARD BARTLESVILLE OK 74006 (918) 333-7200 730 370019 GREAT PLAINS REGIONAL MEDICAL CENTER 1705 WEST 2ND STREET ELK CITY OK 73644 (580) 225-2511 40 370020 VALLEY VIEW REGIONAL HOSPITAL 430 NORTH MONTA VISTA ADA OK 74820 (405) 332-2323 610 370022 JACKSON COUNTY MEMORIAL HOSPITAL 1200 EAST PECAN, P O BOX ALTUS OK 73523 (405) 482-4781 320 370023 DUNCAN REGIONAL HOSPITAL, INC 1407 WHISENANT DRIVE, P O BOX 2000 DUNCAN OK 73533 (405) 252-5300 680 370025 MUSKOGEE REGIONAL MEDICAL CENTER 300 EDNA M ROCKEFELLER DRIVE MUSKOGEE OK 74401 (918) 682-5501 500 370026 ST MARY'S MERCY HOSPITAL 305 SOUTH 5TH STREET ENID OK 73702 (405) 233-6100 230 370028 INTEGRIS BAPTIST MEDICAL CENTER 3300 NORTHWEST EXPRESSWAY OKLAHOMA CITY OK 73112 (405) 949-3166 540 370029 INTEGRIS CLINTON REGIONAL HOSPITAL 100 NORTH 30TH STREET, P O BOX 1569 CLINTON OK 73601 (405) 323-2363 190 370030 INTEGRIS BLACKWELL REGIONAL HOSPITAL 710 SOUTH 13TH STREET BLACKWELL OK 74631 (580) 363-9253 350 370032 DEACONESS HOSPITAL 5501 NORTH PORTLAND AVENUE OKLAHOMA CITY OK 73112 (405) 604-6126 540 370034 MCALESTER REGIONAL HEALTH CENTER 1 CLARK BASS BOULEVARD MCALESTER OK 74501 (918) 426-1800 600 370036 HARMON MEMORIAL HOSPITAL 400 EAST CHESTNUT, P O BOX 791 HOLLIS OK 73550 (580) 688-3363 280 370037 ST ANTHONY HOSPITAL 1000 NORTH LEE AVENUE OKLAHOMA CITY OK 73101 (405) 272-7000 540 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 104 Provider ID Hospital Name Address City State ZIP Telephone County 370039 CLAREMORE REGIONAL HOSPITAL 1201 NORTH MUSKOGEE STREET CLAREMORE OK 74017 (918) 341-2556 650 370040 EASTERN OKLAHOMA MEDICAL CENTER 105 WALL STREET, P O BOX 1148 POTEAU OK 74953 (918) 647-8161 390 370041 BRISTOW MEMORIAL HOSPITAL SPRUCE & 7TH STREETS BRISTOW OK 74010 (918) 367-2215 180 370042 FAIRVIEW HOSPITAL 523 EAST STATE ROAD FAIRVIEW OK 73737 (580) 227-3721 460 370043 INTEGRIS MARSHALL MEMORIAL HOSPITAL 1 HOSPITAL DRIVE MADILL OK 73446 (580) 795-3384 470 370045 OKEENE MUNICIPAL HOSPITAL 207 EAST F STREET OKEENE OK 73763 (580) 822-4417 50 370047 MERCY MEMORIAL HEALTH CENTER 1011 & 1012 14TH AVENUE, NORTHWEST ARDMORE OK 73401 (405) 223-5400 90 370048 MCCURTAIN MEMORIAL HOSPITAL 1301 MEMORIAL ROAD IDABEL OK 74745 (580) 286-7623 440 370049 STILLWATER MEDICAL CENTER 1323 WEST 6TH STREET STILLWATER OK 74076 (405) 372-1480 590 370051 MEMORIAL HOSPITAL & PHYSICIAN 319 EAST JOSEPHINE FREDERICK OK 73542 (580) 335-7565 700 370054 GRADY MEMORIAL HOSPITAL 2220 IOWA STREET CHICKASHA OK 73018 (405) 224-2300 250 370056 COMANCHE COUNTY MEMORIAL HOSPITAL 3401 WEST GORE BOULVARD LAWTON OK 73505 (405) 355-8620 150 370057 OKMULGEE MEMORIAL HOSPITAL 1401 MORRIS DRIVE, P O BOX 1038 OKMULGEE OK 74447 (918) 756-4233 550 370060 PAWNEE MUNICIPAL HOSPITAL 1212 FOURTH STREET PAWNEE OK 74058 (918) 762-2577 580 370064 CARNEGIE TRI-COUNTY MUNICIPAL HOSPITAL 102 NORTH BROADWAY CARNEGIE OK 73015 (580) 654-1050 70 370065 CRAIG GENERAL HOSPITAL 735 NORTH FOREMAN VINITA OK 74301 (918) 256-7551 170 370072 LATIMER COUNTY GENERAL HOSPITAL 806 STATE HIGHWAY 2 NORTH WILBURTON OK 74578 (918) 465-2391 380 370078 TULSA REGIONAL MEDICAL CENTER 744 WEST 9TH STREET & 205 E PINE TULSA OK 74127 (918) 587-2561 710 370080 SHARE MEMORIAL HOSPITAL 800 SHARE DRIVE ALVA OK 73717 (580) 327-2800 750 370082 BEAVER COUNTY MEMORIAL HOSPITAL 212 EAST 8TH STREET, P O BOX 640 BEAVER OK 73932 (580) 625-4551 30 370083 PUSHMATAHA CTY-TN OF ANTLERS HOSP AUTH 510 EAST MAIN STREET ANTLERS OK 74523 (580) 298-3341 630 370084 HASKELL COUNTY HOSPITAL 401 NORTHWEST H STREET STIGLER OK 74462 (918) 967-4682 300 370089 TAHLEQUAH CITY HOSPITAL 1400 EAST DOWNING STREET, P O BOX 1008TAHLEQUAH OK 74465 (918) 456-0641 100 370091 SAINT FRANCIS HOSPITAL, INC 6161 SOUTH YALE & 4818 E 67TH STREET TULSA OK 74136 (918) 494-2200 710 370092 SOUTHWESTERN MEMORIAL HOSPITAL 215 NORTH KANSAS WEATHERFORD OK 73096 (580) 772-5551 190 370093 OU MEDICAL CENTER 700 NORTHEAST 13TH STREET OKLAHOMA CITY OK 73104 (405) 271-5100 540 370094 MIDWEST CITY REG MED CENTER 2825 PARKLAWN DRIVE & 238 N MIDWEST BVMIDWEST CITY OK 73110 (405) 610-8530 540 370095 ARBUCKLE MEMORIAL HOSPITAL 2011 WEST BROADWAY SULPHUR OK 73086 (580) 622-2161 490 370097 SOUTHWESTERN MEDICAL CENTER 5602 SOUTHWEST LEE BOULEVARD LAWTON OK 73505 (405) 531-4700 540 370099 CUSHING MUNICIPAL HOSPITAL 1027 EAST CHERRY STREET, P O BOX 1409 CUSHING OK 74023 (918) 225-2915 590 370100 CHOCTAW MEMORIAL HOSPITAL 1405 EAST KIRK ROAD HUGO OK 74743 (580) 326-6414 110 370103 SAYRE MEMORIAL HOSPITAL, INC 501 EAST WASHINGTON SAYRE OK 73662 (580) 928-5541 40 370105 BONE AND JOINT HOSPITAL 1111 NORTH DEWEY AVENUE OKLAHOMA CITY OK 73103 (405) 272-9671 540 370106 INTEGRIS SOUTHWEST MEDICAL CENTER 4401 SOUTH WESTERN AVENUE OKLAHOMA CITY OK 73109 (405) 636-7777 540 370108 HARPER COUNTY COMMUNITY HOSPITAL U S HIGHWAY 64 NORTH, P O BOX 60 BUFFALO OK 73834 (580) 735-2555 290 370112 SEQUOYAH MEMORIAL HOSPITAL 213 EAST REDWOOD SALLISAW OK 74955 (918) 774-1100 670 370113 GROVE GENERAL HOSPITAL 1310 SOUTH MAIN STREET GROVE OK 74344 (918) 786-2243 200 370114 ST JOHN MEDICAL CENTER, INC 1923 SOUTH UTICA AVENUE TULSA OK 74104 (918) 744-2180 710 370123 ST MICHAEL HOSPITAL 2129 SOUTHWEST 59TH STREET OKLAHOMA CITY OK 73119 (405) 685-6671 540 370125 MANGUM CITY HOSPITAL ONE WICKERSHAM DRIVE MANGUM OK 73554 (580) 782-3353 270 370138 MEMORIAL HOSPITAL OF TEXAS COUNTY 520 MEDICAL DRIVE GUYMON OK 73942 (580) 338-6515 690 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 105 Provider ID Hospital Name Address City State ZIP Telephone County 370139 PERRY MEMORIAL HOSPITAL 501 14TH STREET PERRY OK 73077 (580) 336-3541 510 370148 EDMOND MEDICAL CENTER 1 SOUTH BRYANT EDMOND OK 73034 (405) 341-6100 540 370149 SHAWNEE REGIONAL HOSPITAL 1102 W MACARTHUR, PO BOX 909 SHAWNEE OK 74801 (405) 273-2270 620 370153 ELKVIEW GENERAL HOSPITAL 429 WEST ELM STREET HOBART OK 73651 (580) 726-3324 370 370154 HOLDENVILLE GENERAL HOSPITAL 100 CRESTVIEW DRIVE HOLDENVILLE OK 74848 (405) 379-6631 310 370156 PAULS VALLEY GENERAL HOSPITAL 100 VALLEY DRIVE PAULS VALLEY OK 73075 (405) 238-5501 240 370158 PURCELL MUNICIPAL HOSPITAL 1500 NORTH GREEN AVENUEA1 PURCELL OK 73080 (405) 527-6524 430 370166 WAGONER COMMUNITY HOSPITAL 1200 WEST CHEROKEE STREET WAGONER OK 74467 (918) 485-1200 720 370169 COMMUNITY HOSPITAL LAKEVIEW 1 HOSPITAL DRIVE, BOX 629 EUFAULA OK 74432 (918) 689-2535 450 370170 PHS INDIAN HOSPITAL LAWTON OK 73501 (405) 353-0350 150 370171 W W HASTINGS INDIAN HOSPITAL 100 S BLISS TAHLEQUAH OK 74464 (918) 458-3210 100 370172 CHOCTAW NATION HEALTH SER AUTHORITY ROUTE 2 BOX 1735 TALIHINA OK 74571 (918) 567-2211 380 370173 PHS INDIAN HOSPITAL 101 SOUTH MOORE AVE CLAREMORE OK 74017 (918) 341-8430 650 370174 CLINTON INDIAN HOSPITAL RT 4 BOX 213 CLINTON OK 73601 (405) 323-2884 190 370176 SAINT FRANCIS HOSPITAL AT BROKEN ARROW 3000 SOUTH ELM PLACE BROKEN ARROW OK 74012 (918) 455-3535 710 370177 SEILING MUNICIPAL HOSPITAL AUTHORITY HIGHWAY 60 NORTHEAST SEILING OK 73663 (580) 922-7361 210 370178 MEMORIAL HOSPITAL 1401 WEST LOCUST STILWELL OK 74960 (918) 696-3101 0 370179 CREEK NATION COMMUNITY HOSPITAL 309 NORTH 14TH STREET OKEMAH OK 74859 (918) 623-1424 530 370180 CARL ALBERT INDIAN HEALTH FACILITY 1001 NORTH COUNTRY CLUB ROAD ADA OK 74820 (405) 436-3980 610 370183 HENRYETTA MEDICAL CENTER DEWEY BARTLETT AND MAIN STS, BOX 1269 HENRYETTA OK 74437 (918) 652-4463 550 370186 CORDELL MEMORIAL HOSPITAL 1220 NORTH GLENN ENGLISH STREET CORDELL OK 73632 (580) 832-3339 740 370190 SOUTHWESTERN REGIONAL MEDICAL CENTER 2408 EAST 81ST STREET, SUITE 100 TULSA OK 74137 (918) 496-5500 710 370192 NORTHWEST SURGICAL HOSPITAL 9204 NORTH MAY AVENUE OKLAHOMA CITY OK 73120 (404) 848-1918 540 370196 RENAISSANCE WOMENS CTR OF EDMOND 1800 SOUTH RENAISSANCE BOULEVARD EDMOND OK 73013 (405) 330-6900 540 370199 LAKESIDE WOMEN'S HOSPITAL 11200 NORTH PORTLAND AVENUE OKLAHOMA CITY OK 73120 (405) 936-1500 540 370200 SEMINOLE MEDICAL CENTER 2401 WRANGLER BOULEVARD SEMINOLE OK 74868 (405) 382-0600 660 370201 SURGICAL HOSPITAL OF OKLAHOMA, L L C 100 SOUTHEAST 59TH STREET OKLAHOMA CITY OK 73129 (405) 634-9300 540 370202 SOUTHCREST HOSPITAL 8801 SOUTH 101ST EAST AVENUE TULSA OK 74153 (918) 294-4000 710 370203 PHYSICIANS HOSPITAL OF OKLAHOMA 3100 SOUTHWEST 89TH STREET OKLAHOMA CITY OK 73159 (405) 602-8100 130 370206 OKLAHOMA SPINE HOSPITAL 14101 PARKWAY COMMONS DRIVE OKLAHOMA CITY OK 73134 (405) 749-2700 540 370210 ORTHOPEDIC HOSPITAL OF OKLAHOMA LLC 2408 EAST 81ST STREET, SUITE 900 TULSA OK 74137 (918) 477-5000 710 370211 INTEGRIS CANADIAN VALLEY 1201 HEALTH CENTER PARKWAY YUKON OK 73099 (405) 717-6800 80 370212 OKLA CENTER FOR ORTHOPAEDIC & MULTI-SP 330 SOUTHWEST 80TH STREET OKLAHOMA CITY OK 73139 (405) 602-6500 130 370213 ADVANCE CARE HOSPITAL OF OKLAHOMA CITY 4300 WEST MEMORIAL ROAD, 3RD FLOOR OKLAHOMA CITY OK 73120 (405) 486-8800 540 371300 ATOKA MEMORIAL HOSPITAL 1501 SOUTH VIRGINIA AVENUE ATOKA OK 74525 (580) 889-3333 20 371301 PRAGUE MUNICIPAL HOSPITAL 1322 KLABSUBA AVENUE, DRAWER S PRAGUE OK 74864 (405) 567-4922 400 371302 WATONGA MUNICIPAL HOSPITAL 500 NORTH CLARENCE NASH BOULEVARD WATONGA OK 73772 (580) 623-7211 50 371303 ROGER MILLS MEMORIAL HOSPITAL 501 SOUTH L L MALES AVENUE CHEYENNE OK 73628 (580) 497-3336 640 371304 JOHNSTON MEMORIAL HOSPITAL 1000 SOUTH BRYD TISHOMINGO OK 73460 (580) 371-2127 340 371305 JANE PHILLIPS NOWATA HEALTH CENTER 237 SOUTH LOCUST STREET NOWATA OK 74048 (918) 273-3102 520 371306 MERCY HEALTH LOVE COUNTY 300 WANDA STREET MARIETTA OK 73448 (580) 276-3347 420 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 106 Provider ID Hospital Name Address City State ZIP Telephone County 371307 CIMARRON MEMORIAL HOSPITAL 100 SOUTH ELLIS BOISE CITY OK 73933 (580) 544-2501 120 371308 WETUMKA GENERAL HOSPITAL 325 SOUTH WASHITA WETUMKA OK 74883 (405) 452-3276 310 371309 PAWHUSKA HOSPITAL, INC 1101 EAST 15TH STREET PAWHUSKA OK 74056 (918) 287-3232 560 371310 HEALDTON MUNICIPAL HOSPITAL 918 SOUTHWEST 8TH STREET HEALDTON OK 73438 (580) 229-0701 90 371311 JEFFERSON COUNTRY HOSPITAL INTERSECTION HYWS 81 & 70 WAURIKA OK 73573 (580) 228-2344 330 371312 ST JOHN SAPULPA 1004 EAST BRYAN SAPULPA OK 74066 (918) 224-4280 180 371313 KINGFISHER REGIONAL HOSPITAL 500 SOUTH 9TH STREET KINGFISHER OK 73750 (405) 375-3141 360 371314 ANADARKO MUNICIPAL HOSPITAL 1002 EAST CENTRAL BOULEVARD ANADARKO OK 73005 (405) 247-2551 70 371316 STROUD REGIONAL MEDICAL CENTER 2308 HIGHWAY 66 WEST STROUD OK 74079 (918) 968-3571 400 371317 LOGAN HOSPITAL AND MEDICAL CENTER 200 SOUTH ACADEMY ROAD GUTHRIE OK 73044 (405) 282-6700 410 371318 FAIRFAX MEMORIAL HOSPITAL HIGHWAY 18 & TAFT AVENUE FAIRFAX OK 74637 (918) 642-3291 560 371319 MARY HURLEY HOSPITAL 6 NORTH COVINGTON COALGATE OK 74538 (580) 927-2327 140 371320 CLEVELAND AREA HOSPITAL, INC 1401 WEST PAWNEE CLEVELAND OK 74020 (918) 358-2501 580 372004 VENCOR HOSPITAL - OKLAHOMA CITY 1407 NORTH ROBINSON AVENUE OKLAHOMA CITY OK 73103 (405) 232-8000 540 372005 INTEGRATED SPECIALTY HOSPITAL OF EDMON 1100 E 9TH ST EDMOND OK 73034 (405) 341-5617 540 372006 SELECT SPECIALTY HOSPITAL - TULSA 744 WEST 9TH STREET, 6TH FLOOR TULSA OK 74127 (918) 699-2165 710 372007 HILLCREST SPECIALTY HOSPITAL 2408 EAST 81ST STREET, SUITE 2500 TULSA OK 74137 (918) 491-2400 710 372008 SELECT SPECIALTY HOSPITAL - OKLA CITY 3300 NORTH WEST EXPRESSWAY, 5-EAST,60OKLAHOMA CITY OK 73112 (405) 636-7168 540 372009 SELECT SPECIALTY HOSPITAL - OKLA CITY 5501 NORTH PORTLAND AVENUE, 4TH FLOO OKLAHOMA CITY OK 73112 (405) 951-4016 540 372011 CONTINUOUS CARE CENTER OF TULSA 1923 SOUTH UTICA AVENUE TULSA OK 74104 (918) 749-8930 710 372012 INTEGRATED SPECIALTY HOSPITAL OF M C 8210 NATIONAL AVENUE MIDWEST CITY OK 73110 (405) 739-0800 540 372015 CENTRIS 4401 SOUTH WESTERN, SEVENTH FLOOR OKLAHOMA CITY OK 73109 (405) 644-5007 540 372016 INTEGRIS BASS PAVILION 401 SOUTH THIRD ENID OK 73701 (580) 233-2300 230 373025 HEALTHSOUTH REHABILITATION HOSPITAL 700 NW 7TH STREET & 721 NW 6TH STREET OKLAHOMA CITY OK 73102 (405) 236-3131 540 373026 GEORGE NIGH REBABILITATION INSTITUTE 900 EAST AIRPORT ROAD OKMULGEE OK 74447 (918) 756-9211 550 373029 MEADOWBROOK REHAB HOSPITAL OF TULSA 3219 SOUTH 79TH EAST AVENUE TULSA OK 74145 (918) 663-8183 710 373300 J D MCCARTY CENTER FOR CHILDREN 1125 EAST ALAMEDA STREET NORMAN OK 73071 (405) 321-4830 130 373302 CHILDREN'S CENTER,THE 6800 NORTHWEST 39TH EXRPESSWAY BETHANY OK 73008 (405) 789-6711 540 374000 GRIFFIN MEMORIAL HOSPITAL 900 E MAIN ST PO BOX 151 NORMAN OK 73070 (405) 321-4880 130 374001 WESTERN STATE HOSPITAL 1 MILE EAST US HIGHWAY 270 1 FORT SUPPLY OK 73841 (580) 766-2311 760 374005 PARKSIDE 1619 EAST 13TH STREET TULSA OK 74120 (918) 582-2131 710 374006 CARL ALBERT COMM MENTAL HEALTH CENTER 1101 EAST MONROE MCALESTER OK 74502 (918) 426-1000 600 374008 JIM TALIAFERRO COMM MENTAL HEALTH CTR 602 SOUTHWEST 38TH STREET LAWTON OK 73505 (580) 248-5780 150 374012 BROOKHAVEN HOSPITAL, INC 201 SOUTH GARNETT ROAD TULSA OK 74128 (918) 438-4257 710 374016 ROLLING HILLS HOSPITAL 1000 ROLLING HILLS LANE ADA OK 74820 (405) 436-3600 610 374017 WILLOW CREST HOSPITAL 130 A STREET SOUTHWEST MIAMI OK 74354 (918) 542-1836 570 374020 LAUREATE PSYCHIATRIC CL AND HOSP 6655 S YALE AVE BOX 470207 TULSA OK 74147 (918) 481-4000 710 374021 PARKSIDE 1619 EAST 13TH STREET TULSA OK 74120 (918) 582-2131 710 380001 MID-COLUMBIA MEDICAL CENTER 1700 EAST 19TH STREET THE DALLES OR 97058 (541) 296-1111 320 380002 THREE RIVERS COMM HOSP AND HEALTH CTR 715 NW DIMMICK GRANTS PASS OR 97526 (541) 472-7372 160 380003 SAMARITAN PACIFIC COMMUNITIES HOSPITAL 930 SW ABBEY STREET NEWPORT OR 97365 (541) 265-2244 200 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 107 Provider ID Hospital Name Address City State ZIP Telephone County 380004 PROVIDENCE ST VINCENT MEDICAL CENTER 9205 SW BARNES ROAD PORTLAND OR 97225 (503) 216-1234 330 380005 ASHLAND COMMUNITY HOSPITAL 280 MAPLE STREET, PO BOX 98 ASHLAND OR 97520 (541) 482-2441 140 380006 PROVIDENCE HOOD RIVER MEMORIAL HOSP 13TH AND MAY STREETS, PO BOX 149 HOOD RIVER OR 97031 (541) 386-3911 130 380007 LEGACY EMANUEL HOSPITAL & HEALTH CTR 2801 NO GANTENBEIN AVENUE PORTLAND OR 97227 (503) 413-2200 250 380008 MID VALLEY HEALTHCARE/LEBANON COMMUNITY HOSPITAL, 525 N SANTIAM HWYLEBANON OR 97355 (541) 451-7039 210 380009 OHSU HOSPITAL AND CLINICS AND DOERNBEC 3181 SW SAM JACKSON PARK ROAD PORTLAND OR 97201 (503) 494-7500 250 380010 WOODLAND PARK HOSPITAL 10300 NE HANCOCK ST PORTLAND OR 97220 (503) 257-5698 250 380011 ST ELIZABETH HEALTH SERVICES, INC 3325 POCAHONTAS ROAD BAKER CITY OR 97814 (541) 523-6461 0 380013 PEACE HARBOR HOSPITAL 400 9TH STREET, PO BOX 580 FLORENCE OR 97439 (541) 997-8412 190 380014 GOOD SAMARITAN REGIONAL MEDICAL CTR 3600 NW SAMARITAN DRIVE CORVALLIS OR 97330 (541) 768-5111 10 380017 LEGACY GOOD SAMARITAN HOSP & MED CTR 1015 NW 22ND AVE PORTLAND OR 97210 (503) 413-2200 250 380018 ROGUE VALLEY MEDICAL CENTER 2825 BARNETT ROAD MEDFORD OR 97504 (541) 608-4900 140 380019 PIONEER MEMORIAL HOSPITAL 1201 NORTH NE ELM STREET PRINEVILLE OR 97754 (541) 447-6254 60 380020 MCKENZIE-WILLAMETTE HOSPITAL, INC 1460 G STREET SPRINGFIELD OR 97477 (541) 726-4400 190 380021 TUALITY HEALTHCARE 335 SE 8TH AVENUE HILLSBORO OR 97123 (503) 681-1111 330 380022 SAMARITAN ALBANY GENERAL HOSPITAL 1046 6TH AVENUE SW ALBANY OR 97321 (541) 812-4000 10 380023 GOOD SHEPHERD MEDICAL CENTER 610 NW 11TH AVENUE HERMISTON OR 97838 (541) 812-4752 290 380025 LEGACY MOUNT HOOD MEDICAL CENTER 24800 SE STARK STREET GRESHAM OR 97030 (503) 674-1122 250 380026 COLUMBIA MEMORIAL HOSPITAL 2111 EXCHANGE STREET ASTORIA OR 97103 (503) 325-4321 30 380027 MERCY MEDICAL CENTER INC 2700 STEWART PARKWAY ROSEBURG OR 97470 (541) 673-0611 90 380029 SILVERTON HOSPITAL 342 FAIRVIEW STREET SILVERTON OR 97381 (503) 873-1500 230 380033 SACRED HEART MEDICAL CENTER 1255 HILYARD STREET EUGENE OR 97401 (541) 686-7300 190 380035 GRANDE RONDE HOSPITAL 900 SUNSET DRIVE, PO BOX 3290 LA GRANDE OR 97850 (541) 963-8421 300 380037 PROVIDENCE NEWBERG HOSPITAL 501 VILLA ROAD NEWBERG OR 97132 (503) 537-1555 350 380038 WILLAMETTE FALLS HOSPITAL 1500 DIVISION STREET OREGON CITY OR 97045 (503) 656-1631 20 380039 EASTMORELAND HOSPITAL 2900 SE STEELE STREET PORTLAND OR 97202 (503) 234-0411 250 380040 CENTRAL OREGON DISTRICT HOSPITAL 1253 NORTH CANAL BOULEVARD REDMOND OR 97756 (541) 548-8131 80 380047 CHS,INC DBA ST CHARLES MEDICAL CTR 2500 NE NEFF RD BEND OR 97701 (541) 382-4321 80 380050 MERLE WEST MEDICAL CENTER 2865 DAGGETT STREET KLAMATH FALLS OR 97601 (541) 882-6311 170 380051 SALEM HOSPITAL 2561 CENTER ST NE AND 665 WINTER ST SE SALEM OR 97301 (503) 370-5200 230 380052 HOLY ROSARY MEDICAL CENTER 351 SW 9TH STREET ONTARIO OR 97914 (541) 881-7000 220 380056 SANTIAM MEMORIAL HOSPITAL 1401 NORTH 10TH AVENUE STAYTON OR 97383 (503) 769-2175 230 380060 ADVENTIST MEDICAL CENTER 10123 SE MARKET PORTLAND OR 97216 (503) 257-2500 250 380061 PROVIDENCE PORTLAND MEDICAL CENTER 4805 NE GLISAN PORTLAND OR 97213 (503) 215-1111 250 380066 ST ANTHONY HOSPITAL 1601 SE COURT AVENUE PENDLETON OR 97801 (541) 276-5121 290 380070 TILLAMOOK COUNTY GENERAL HOSPITAL 1000 THIRD ST TILLAMOOK OR 97141 (503) 842-4444 280 380071 WILLAMETTE VALLEY MEDICAL CTR 2700 THREE MILE LANE MCMINNVILLE OR 97128 (503) 472-6131 350 380072 CURRY GENERAL HOSPITAL 94220 4TH STREET GOLD BEACH OR 97444 (541) 247-6621 70 380075 PROVIDENCE MEDFORD MEDICAL CENTER 1111 CRATER LAKE AVENUE MEDFORD OR 97504 (541) 732-5000 140 380081 MOUNTAIN VIEW HOSPITAL 470 NE A STREET MADRAS OR 97741 (541) 475-3882 150 380082 PROVIDENCE MILWAUKIE HOSPITAL 10150 SE 32ND AVENUE MILWAUKIE OR 97222 (503) 513-8300 20 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 108 Provider ID Hospital Name Address City State ZIP Telephone County 380087 COQUILLE VALLEY HOSPITAL 940 EAST 5TH STREET COQUILLE OR 97423 (541) 396-3101 50 380089 LEGACY MERIDIAN PARK HOSPITAL 19300 SW 65TH AVENUE TUALATIN OR 97062 (503) 692-1212 330 380090 BAY AREA HOSPITAL 1775 THOMPSON ROAD COOS BAY OR 97420 (541) 269-8124 50 380091 KAISER SUNNYSIDE MEDICAL CENTER 10180 SE SUNNYSIDE ROAD CLACKAMAS OR 97015 (503) 652-2880 20 381301 COTTAGE GROVE COMMUNITY HOSPITAL 1340 BIRCH AVENUE COTTAGE GROVE OR 97424 (541) 942-6684 190 381302 SAMARITAN NORTH LINCOLN HOSPITAL 3043 NE 28TH STREET,PO BOX 767 LINCOLN CITY OR 97367 (541) 996-7100 200 381303 PROVIDENCE SEASIDE HOSPITAL 725 SOUTH WAHANNA ROAD SEASIDE OR 97138 (503) 717-7000 30 381304 SOUTHERN COOS GENERAL HOSPITAL 900 ELEVENTH STREET SE BANDON OR 97411 (541) 347-2426 50 381305 BLUE MOUNTAIN HOSPITAL DISTRICT 170 FORD ROAD JOHN DAY OR 97845 (541) 575-1311 110 381306 WALLOWA MEMORIAL HOSPITAL 401 EAST FIRST STREET, P O BOX 460 ENTERPRISE OR 97828 (541) 426-3111 310 381307 HARNEY DISTRICT HOSPITAL 557 WEST WASHINGTON STREET BURNS OR 97720 (541) 573-7281 120 381308 VALLEY COMMUNITY HOSPITAL 550 SE CLAY STREET PO BOX 378 DALLAS OR 97338 (503) 623-8301 260 381309 LAKE DISTRICT HOSPITAL 700 SOUTH J STREET LAKEVIEW OR 97630 (541) 947-2114 180 381310 PIONEER MEMORIAL HOSPITAL 564 EAST PIONEER DRIVE- PO BOX 9 HEPPNER OR 97836 (541) 676-9133 240 381311 LOWER UMPQUA HOSPITAL 600 RANCH ROAD REEDSPORT OR 97467 (541) 271-2171 90 384008 OREGON STATE HOSPITAL DISTINCT PART 2600 CENTER STREET NE SALEM OR 97310 (503) 945-2800 230 384009 LANE COUNTY PSYCHIATRIC HOSPITAL 151 W 5TH AVE,PO BOX 10905 EUGENE OR 97401 (541) 682-2280 190 384011 EASTERN OREGON PSYCHIATRIC CENTER 2600 WESTGATE PENDLETON OR 97801 (541) 276-0810 290 390001 COMMUNITY MEDICAL CENTER 1822 MULBERRY ST SCRANTON PA 18510 (717) 969-8241 420 390002 UPMC MCKEESPORT HOSPITAL 1500 FIFTH AVENUE MC KEESPORT PA 15132 (412) 664-2000 10 390003 BLOOMSBURG HOSPITAL 549 EAST FAIR STREET BLOOMSBURG PA 17815 (570) 387-2100 250 390004 HOLY SPIRIT HOSPITAL 503 NORTH 21ST STREET CAMP HILL PA 17011 (717) 763-2100 270 390005 CORRY MEMORIAL HOSPITAL 612 W SMITH ST CORRY PA 16407 (814) 664-4641 320 390006 GEISINGER MEDICAL CENTER N ACADEMY AVE DANVILLE PA 17822 (717) 271-6211 580 390008 ELLWOOD CITY HOSPITAL 724 PERSHING ST ELLWOOD CITY PA 16117 (724) 752-0081 450 390009 SAINT VINCENT HEALTH CENTER 232 WEST 25TH STREET ERIE PA 16544 (814) 452-5000 320 390010 JEANNETTE DISTRICT MEMORIAL HOSPITAL 600 JEFFERSON AVE JEANNETTE PA 15644 (412) 527-3551 770 390011 LEE HOSPITAL 320 MAIN ST JOHNSTOWN PA 15901 (814) 533-0123 160 390012 CENTRAL MONTGOMERY MEDICAL CENTER 100 MEDICAL CAMPUS DRIVE LANSDALE PA 19446 (215) 368-2100 560 390013 EVANGELICAL COMMUNITY HOSPITAL ONE HOSPITAL DRIVE LEWISBURG PA 17837 (717) 523-2500 720 390016 JAMESON MEMORIAL HOSPITAL 1211 WILMINGTON AVENUE NEW CASTLE PA 16105 (724) 658-9001 450 390017 ST FRANCIS HOSPITAL OF NEW CASTLE 1000 SOUTH MERCER STREET NEW CASTLE PA 16101 (724) 658-3511 450 390019 PALMERTON HOSPITAL 135 LAFAYETTE AVE PALMERTON PA 18071 (215) 826-3141 190 390022 ST AGNES MEDICAL CENTER 1900 S BROAD ST PHILADELPHIA PA 19145 (215) 339-4100 620 390023 TEMPLE EAST INC FRANKFORD AVE & PALMER STREET PHILADELPHIA PA 19125 (215) 291-2000 620 390024 WILLS EYE HOSPITAL 9TH WALNUT ST PHILADELPHIA PA 19107 (215) 928-3000 620 390025 KENSINGTON HOSPITAL 136 W DIAMOND STREET PHILADELPHIA PA 19122 (215) 426-8100 620 390026 CHESTNUT HILL HOSPITAL 8835 GERMANTOWN AVE PHILADELPHIA PA 19118 (215) 248-8200 620 390027 TEMPLE UNIVERSITY HOSPITAL 3401 N BROAD ST 400 CARNELL HALL PHILADELPHIA PA 19140 (215) 707-4162 620 390028 MERCY HOSPITAL OF PITTSBURGH 1400 LOCUST STREET PITTSBURGH PA 15219 (412) 232-8111 10 390030 POTTSVILLE HOSPITAL-WARNE CLINIC 420 S JACKSON ST POTTSVILLE PA 17901 (570) 621-5000 650 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 109 Provider ID Hospital Name Address City State ZIP Telephone County 390031 GOOD SAMARITAN REGIONAL MEDICAL CENTER 700 EAST NORWEGIAN STREET POTTSVILLE PA 17901 (717) 621-4000 650 390032 ALLE-KISKI MEDICAL CENTER 1301 CARLISLE ST NATRONA HEIGHTS PA 15065 (412) 224-5100 10 390035 ST LUKES QUAKERTOWN HOSPITAL 11TH ST & PARK AVE QUAKERTOWN PA 18951 (215) 536-1842 140 390036 MEDICAL CENTER BEAVE PA 1000 DUTCH RIDGE RD BEAVER PA 15009 (412) 728-7000 80 390037 SEWICKLEY VALLEY HOSPITAL 720 BLACKBURN ROAD SEWICKLEY PA 15143 (412) 741-6600 10 390039 SOMERSET COMM HOSP 225 S CENTER AVE SOMERSET PA 15501 (717) 398-0100 680 390041 UNIONTOWN HOSPITAL 500 W BERKLEY ST UNIONTOWN PA 15401 (412) 430-5000 330 390042 WASHINGTON HOSPITAL 155 WILSON AVENUE WASHINGTON PA 15301 (724) 223-3001 750 390043 SOLDIERS & SAILORS MEMORIAL HOSPITAL 32-36 CENTRAL AVE WELLSBORO PA 16901 (717) 724-1631 710 390044 READING HOSPITAL MEDICAL CENTER 6TH AVE AND SPRUCE ST READING PA 19603 (215) 378-6000 110 390045 WILLIAMSPORT HOSPITAL 777 RURAL AVE WILLIAMSPORT PA 17701 (717) 321-1000 510 390046 YORK HOSPITAL 1001 SOUTH GEORGE STREET YORK PA 17405 (717) 851-2345 800 390048 LEWISTON HOSPITAL 400 HIGHLAND AVENUE LEWISTOWN PA 17044 (717) 248-5411 540 390049 ST LUKES HOSPITAL OF BETHLEHEM 801 OSTRUM ST BETHLEHEM PA 18015 (215) 691-4200 590 390050 ALLEGHENY GENERAL HOSPITAL 320 EAST NORTH AVENUE PITTSBURGH PA 15212 (412) 359-6000 10 390052 CLEARFIELD HOSP 809 TURNPIKE AVE CLEARFIELD PA 16830 (814) 765-5341 130 390054 HAZLETON-ST JOSEPH MEDICAL CENTER 687 N CHURCH ST HAZLETON PA 18201 (717) 459-4444 480 390055 UPMC SHADYSIDE 5230 CENTRE AVE PITTSBURGH PA 15232 (412) 623-2010 10 390056 J C BLAIR MEMORIAL HOSPITAL WARM SPRINGS AVE HUNTINGDON PA 16652 (814) 643-2290 380 390057 GRAND VIEW HOSPITAL 700 LAWN AVENUE SELLERSVILLE PA 18960 (215) 453-4615 140 390058 CARLISLE REGIONAL MEDICAL CENTER 246 PARKER ST CARLISLE PA 17013 (717) 245-5110 270 390061 LANCASTER REGIONAL MEDICAL CENTER 250 COLLEGE AVENUE LANCASTER PA 17604 (717) 291-8022 440 390062 NASON HOSPITAL 105 NASON DRIVE ROARING SPRING PA 16673 (814) 224-2141 120 390063 HAMOT MEDICAL CENTER 201 STATE ST ERIE PA 16550 (814) 870-6000 320 390065 GETTYSBURG HOSPITAL 147 GETTYS ST GETTYSBURG PA 17325 (717) 334-2121 0 390066 GOOD SAMARITAN HOSPITAL FOURTH WALNUT STREETS LEBANON PA 17042 (717) 270-7500 460 390067 PINNACLE HEALTH SYSTEM 111 SOUTH FRONT STREET HARRISBURG PA 17104 (717) 231-8200 280 390068 COMMUNITY HOSPITAL OF LANCASTER 1100 EAST ORANGE STREET PO BOX 3002 LANCASTER PA 17604 (717) 239-4356 440 390070 TEMPLE LOWER BUCKS HOSPITAL 501 BATH ROAD BRISTOL PA 19007 (215) 785-9200 140 390071 LOCK HAVEN HOSPITAL 24 CREE DRIVE LOCK HAVEN PA 17745 (717) 893-5000 240 390072 BERWICK HOSPITAL CENTER 701 EAST 16TH ST BERWICK PA 18603 (570) 753-5000 250 390073 ALTOONA HOSPITAL 620 HOWARD AVENUE ALTOONA PA 16601 (814) 946-2011 120 390074 SUBURBAN GENERAL HOSPITAL 100 SOUTH JACKSON AVENUE PITTSBURGH PA 15202 (412) 734-6136 10 390075 DIVINE PROVIDENCE HOSPITAL 1100 GRAMPIAN BLVD WILLIAMSPORT PA 17701 (717) 326-8000 510 390076 BRANDYWINE HOSPITAL 201 REESEVILLE ROAD COATESVILLE PA 19320 (215) 383-8005 210 390079 ROBERT PACKER HOSP GUTHRIE SQUARE SAYRE PA 18840 (717) 888-6666 130 390080 JEANES HOSPITAL 7600 CENTRAL AVE PHILADELPHIA PA 19111 (215) 728-2000 620 390081 DELAWARE COUNTY MEMORIAL HOSPITAL LANSDOWNE KEYSTONE AVES DREXEL HILL PA 19026 (215) 284-8100 290 390084 SUNBURY COMMUNITY HOSP 350 NORTH 11TH STREET SUNBURY PA 17801 (717) 286-3333 600 390086 DUBOIS REGNL MED CNTR PO BOX 447 MAPLE AVE & 100 HOSP AV DUBOIS PA 15801 (814) 371-2200 230 390090 WESTERN PENNSYLVANIA HOSPITAL 4800 FRIENDSHIP AVE PITTSBURGH PA 15224 (412) 578-5000 10 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 110 Provider ID Hospital Name Address City State ZIP Telephone County 390091 UPMC NORTHWEST 1 SPRUCE ST FRANKLIN PA 16323 (814) 437-7000 730 390093 CLARION HOSPITAL ONE HOSPITAL DRIVE CLARION PA 16214 (814) 226-9500 220 390095 MARIAN COMMUNITY HOSPITAL 100 LINCOLN AVENUE CARBONDALE PA 18407 (717) 282-2100 420 390096 ST JOSEPH MEDICAL CENTER 145 N 6TH STREET READING PA 19601 (610) 376-2100 110 390097 HOLY REDEEMER HOSPITAL & MED CENTER 1648 HUNTINGDON PIKE MEADOWBROOK PA 19046 (215) 947-3000 560 390100 LANCASTER GENERAL HOSPITAL 555 NORTH DUKE STREET LANCASTER PA 17604 (717) 290-5511 440 390101 MEMORIAL HOSPITAL YORK 325 SOUTH BELMONT STREET YORK PA 17403 (717) 843-8623 800 390102 UPMC ST MARGARET 815 FREEPORT ROAD PITTSBURGH PA 15215 (412) 784-4000 10 390103 MONSOUR MEDICAL CENTER 70 LINCOLN WAY EAST JEANNETTE PA 15644 (412) 527-1511 770 390104 KANE COMMUNITY HOSPITAL NORTH FRALEY STREET, PO BOX 778 KANE PA 16735 (814) 837-8585 520 390107 UPMC PASSAVANT 9100 BABCOCK BOULEVARD PITTSBURGH PA 15237 (412) 367-6700 10 390108 MONTGOMERY HOSPITAL POWELL & FORNANCE STREETS NORRISTOWN PA 19401 (610) 270-2000 560 390109 MID-VALLEY HOSPITAL 1400 SOUTH MAIN STREET PECKVILLE PA 18452 (570) 383-5500 420 390110 CONEMAUGH VALLEY MEM HOSP 1086 FRANKLIN STREET JOHNSTOWN PA 15905 (814) 533-9000 160 390111 HOSPITAL OF UNIV OF PENNSYLVANIA 34TH & SPRUCE STS PHILADELPHIA PA 19104 (215) 662-4000 620 390112 WINDBER HOSPITAL 600 SOMERSET AVENUE WINDBER PA 15963 (814) 467-6611 680 390113 MEADVILLE MEDICAL CENTER 751 LIBERTY ST MEADVILLE PA 16335 (814) 333-5000 260 390114 MAGEE WOMENS HOSP OF THE UPMC HELTH SY 300 HALKET STREET PITTSBURGH PA 15213 (412) 647-4460 10 390115 FRANKFORD HOSPITAL RED LION KNIGHTS RDS PHILADELPHIA PA 19114 (215) 934-4000 620 390116 MERCY SUBURBAN HOSPITAL 2701 DEKALB PIKE NORRISTOWN PA 19401 (215) 278-2000 560 390117 UPMC BEDFORD 10455 LINCOLN HIGHWAY EVERETT PA 15537 (814) 623-3518 100 390118 BRADFORD REGIONAL MEDICAL CENTER 116 INTERSTATE PARKWAY BOX 218 BRADFORD PA 16701 (814) 368-4143 520 390119 MOSES TAYLOR HOSPITAL 700 QUINCY AVE SCRANTON PA 18510 (717) 963-2100 420 390121 BON SECOURS MERCY HOSPITAL 2500 SEVENTH AVE ALTOONA PA 16602 (814) 944-1681 120 390122 TITUSVILLE HOSP 406 W OAK ST TITUSVILLE PA 16354 (814) 827-1851 260 390123 POTTSTOWN MEMORIAL MEDICAL CENTER HIGH STREET & FIRESTONE ROAD POTTSTOWN PA 19464 (215) 327-7000 560 390125 WAYNE MEMORIAL HOSPITAL 601 PARK STREET HONESDALE PA 18431 (717) 253-8100 760 390127 PHOENIXVILLE HOSP UNIV OF PA HLTH SYS 144 NUTT ROAD PHOENIXVILLE PA 19460 (215) 983-1000 210 390128 UNIV OF PITTSBURGH MED CNTR BRADDOCK 400 HOLLAND AVE BRADDOCK PA 15104 (412) 636-5000 10 390130 MINERS HOSPITAL 290 HAIDA AVENUE HASTINGS PA 16646 (814) 247-3100 160 390131 UPMC SOUTH SIDE 2000 MARY STREET PITTSBURGH PA 15203 (412) 488-5598 10 390132 ST JOSEPH HOSPITAL 16TH STREET & GIRARD AVENUE PHILADELPHIA PA 19122 (215) 787-2000 620 390133 LEHIGH VALLEY HOSPITAL 1200 S CEDAR CREST BLVD P O BOX 689 ALLENTOWN PA 18105 (215) 778-8100 470 390135 ROXBOROUGH MEMORIAL HOSPITAL 5800 RIDGE AVENUE PHILADELPHIA PA 19128 (215) 487-4207 620 390136 MERCY PROVIDENCE HOSPITAL, INC 1004 ARCH ST PITTSBURGH PA 15212 (412) 323-5600 10 390137 WVHCS HOSPITAL INC 575 NORTH RIVER STREET WILKES-BARRE PA 18764 (570) 283-7010 480 390138 WAYNESBORO HOSPITAL E MAIN ST WAYNESBORO PA 17268 (717) 765-4000 350 390139 MAIN LINE HOSPITAL-BRYN MAWR CAMPUS BRYN MAWR AVE BRYN MAWR PA 19010 (215) 526-3000 290 390142 ALBERT EINSTEIN MEDICAL CENTER YORK & TABOR RDS PHILADELPHIA PA 19141 (215) 456-6090 620 390145 WESTMORELAND REGIONAL HOSPITAL 532 W PITTSBURGH ST GREENSBURG PA 15601 (412) 832-4000 770 390146 WARREN GENERAL HOSPITAL CRESCENT PARK WEST WARREN PA 16365 (814) 723-3300 740 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 111 Provider ID Hospital Name Address City State ZIP Telephone County 390147 MONONGAHELA VALLEY HOSPITAL INC COUNTRY CLUB RD RT 88 MONONGAHELA PA 15063 (412) 258-2000 750 390150 GREENE COUNTY MEMORIAL HOSPITAL 350 BONAR AVENUE WAYNESBURG PA 15370 (724) 627-3101 370 390151 CHAMBERSBURG HOSPITAL 112 N 7 ST PO BOX 187 CHAMBERSBURG PA 17201 (717) 264-5171 350 390152 TYRONE HOSP CLAY AVE EXTENSION TYRONE PA 16686 (814) 684-1255 120 390153 MAIN LINE HOSPITAL, INC PAOLI 255 W LANCASTER AVENUE PAOLI PA 19301 (610) 648-1000 210 390154 ELK REGIONAL HEALTH CENTER JOHNSONBURG RD SAINT MARYS PA 15857 (814) 781-7500 310 390156 MERCY FITZGERALD HOSPITAL LANSDOWNE & BAILY RDS DARBY PA 19023 (215) 237-4000 290 390157 OHIO VALLEY GENL HOSP 100 HECKEL RD MCKEES ROCKS PA 15136 (412) 777-6280 10 390160 CANONSBURG GENERAL HOSPITAL 100 MEDICAL BOULEVARD CANONSBURG PA 15317 (412) 745-6100 750 390162 EASTON HOSPITAL 21ST & LEHIGH STS EASTON PA 18042 (215) 250-4000 590 390163 ARMSTRONG COUNTY MEMORIAL HOSPITAL ONE NOLTE DRIVE KITTANNING PA 16201 (724) 543-8500 70 390164 UPMC, PRESBYTERIAN 200 LOTHROP STREET PITTSBURGH PA 15213 (412) 647-2345 10 390166 BROWNSVILLE GENERAL HOSPITAL 125 SIMPSON RD BROWNSVILLE PA 15417 (412) 785-1701 330 390168 BUTLER MEMORIAL HOSPITAL 911 EAST BRADY STREET BUTLER PA 16001 (412) 284-4400 150 390169 MERCY HOSPITAL 25 CHURCH ST PO BX 658 WILKES BARRE PA 18765 (717) 826-3100 480 390173 INDIANA HOSPITAL HOSPITAL ROAD, BOX 788 INDIANA PA 15701 (412) 357-7000 390 390174 THOMAS JEFFERSON UNIVERSITY HOSPITAL 10TH AND WALNUT STREET PHILADELPHIA PA 19107 (215) 955-7022 620 390176 ALIQUIPPA COMMUNITY HOSPITAL A 2500 HOSPITAL DRIVE ALIQUIPPA PA 15001 (724) 857-1212 80 390178 UPMC HORIZON 110 NORTH MAIN STREET GREENVILLE PA 16125 (412) 588-2100 530 390179 CHESTER COUNTY HOSPITAL 701 EAST MARSHALL ST WEST CHESTER PA 19380 (215) 431-5101 210 390180 CROZER CHESTER MEDICAL CENTER ONE MEDICAL CENTER BOULEVARD CHESTER PA 19013 (215) 447-2000 290 390181 ASHLAND REGIONAL MEDICAL CENTER 101 BROAD STREET ROUTE 61 ASHLAND PA 17921 (570) 875-2000 650 390183 ST LUKE'S MINERS MEMORIAL HOSPITAL 360 WEST RUDDLE STREET COALDALE PA 18218 (717) 645-2131 650 390184 HIGHLANDS HOSPITAL 401 EAST MURPHY AVENUE CONNELLSVILLE PA 15425 (724) 628-1500 330 390185 HAZLETON GENERAL HOSPITAL 700 E BROAD ST HAZLETON PA 18201 (717) 450-4357 480 390189 SHAMOKIN AREA COMMUNITY HOSPITAL 4200 HOSPITAL ROAD COAL TOWNSHIP PA 17866 (717) 644-4200 600 390191 BROOKVILLE HOSPITAL 100 HOSPITAL ROAD BROOKVILLE PA 15825 (814) 849-2312 400 390192 TYLER MEMORIAL HOSPITAL ROUTE 6 RD 1 TUNKHANNOCK PA 18657 (717) 836-2161 790 390193 METRO HEALTH CENTER 252 ELEVENTH ST ERIE PA 16501 (814) 455-3961 320 390194 GNADEN HUETTEN MEMORIAL HOSPITAL 11TH & HAMILTON STS LEHIGHTON PA 18235 (607) 377-1300 190 390195 MAIN LINE HOSPITALS, INC - LANKENAU LANCASTER & CITY LINE AVE WYNNEWOOD PA 19096 (215) 645-2025 560 390196 HOSPITAL OF THE FOX CHASE CANCER CENTE 7701 BURHOLME AVENUE PHILADELPHIA PA 19111 (215) 728-2498 620 390197 SACRED HEART HOSPITAL 421 CHEW ST ALLENTOWN PA 18102 (215) 776-4900 470 390198 MILLCREEK COMMUNITY HOSPITAL 5515 PEACH ST ERIE PA 16509 (814) 864-4031 320 390199 PUNXSUTAWNEY AREA HOSPITAL 81 HILLCREST DRIVE PUNXSUTAWNEY PA 15767 (814) 938-1800 400 390200 LANCASTER GENERAL HOSPITAL SUSQUEHANNA 631 POPLAR STREET COLUMBIA PA 17512 (717) 684-2841 440 390201 POCONO MEDICAL CENTER 206 E BROWN ST EAST STROUDSBURG PA 18301 (717) 421-4000 550 390203 DOYLESTOWN HOSPITAL 595 W STATE ST DOYLESTOWN PA 18901 (215) 345-2200 140 390204 NAZARETH HOSPITAL 2601 HOLME AVE PHILADELPHIA PA 19152 (215) 335-6000 620 390211 SHARON REGIONAL HEALTH SYSTEM 740 EAST STATE STREET SHARON PA 16146 (412) 983-3911 530 390217 FRICK HOSPITAL 508 SOUTH CHURCH ST MOUNT PLEASANT PA 15666 (412) 547-1500 770 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 112 Provider ID Hospital Name Address City State ZIP Telephone County 390219 LATROBE AREA HOSPITAL 121 WEST 2ND AVENUE LATROBE PA 15650 (724) 537-1000 770 390220 SOUTHERN CHESTER COUNTY MED CENTER 1015 W BALTIMORE PK WEST GROVE PA 19390 (215) 869-1000 210 390222 RIDDLE MEMORIAL HOSPITAL 1068 WEST BALTIMORE PIKE MEDIA PA 19063 (215) 566-9400 290 390223 PRESBYTERIAN-U OF PA MEDICAL CENTER 51 NORTH 39TH STREET PHILADELPHIA PA 19104 (215) 662-8000 620 390224 BARNES KASSON COUNTY HOSPITAL 400 TURNPIKE ST SUSQUEHANNA PA 18847 (570) 853-3135 700 390225 EPHRATA COMMUNITY HOSPITAL 169 MARTIN AVENUE EPHRATA PA 17522 (717) 738-6411 440 390226 PENNSYLVANIA HOSPITAL,THE 800 SPRUCE STS PHILADELPHIA PA 19107 (215) 829-3000 620 390228 ST CLAIR MEMORIAL HOSPITAL 1000 BOWER HILL ROAD PITTSBURGH PA 15243 (412) 561-4900 10 390231 ABINGTON MEMORIAL HOSPITAL 1200 OLD YORK RD ABINGTON PA 19001 (215) 576-2000 560 390233 HANOVER GENERAL HOSPITAL 300 HIGHLAND AVE HANOVER PA 17331 (717) 637-3711 800 390236 MEMORIAL HOSPITAL INC ONE HOSPITAL DRIVE TOWANDA PA 18848 (717) 265-2191 130 390237 MERCY HOSPITAL 746 JEFFERSON AVE SCRANTON PA 18501 (717) 348-7101 420 390246 CHARLES COLE MEMORIAL HOSPITAL 1001 EAST STROUDSBURG STREET COUDERSPORT PA 16915 (814) 274-9300 640 390249 MONTROSE GENERAL HOSPITAL 3 GROW AVENUE MONTROSE PA 18801 (570) 278-3801 700 390256 MILTON S HERSHEY MEDICAL CENTER,THE 500 UNIVERSITY DRIVE HERSHEY PA 17033 (717) 531-8521 280 390258 ST MARY MEDICAL CENTER LANGHORNE-NEWTOWN RD LANGHORNE PA 19047 (215) 750-2003 140 390263 MUHLENBERG HOSPITAL CENTER 2545 SCHOENERSVILLE ROAD BETHLEHEM PA 18017 (610) 861-2200 590 390265 JEFFERSON REGIONAL MEDICAL CENTER COAL VALLEY RD PITTSBURGH PA 15236 (412) 469-5000 10 390266 UNITED COMMUNITY HOSPITAL 102 CRANBERRY ROAD GROVE CITY PA 16127 (412) 458-5442 530 390267 FORBES REGIONAL HOSPITAL 2570 HAYMAKER RD MONROEVILLE PA 15146 (412) 273-2424 10 390268 CENTRE COMMUNITY HOSPITAL 1800 E PARK AVE STATE COLLEGE PA 16803 (814) 238-4351 200 390270 PENN STATE GEISINGERY WYOMING VALLEY 1000 E MTN DRIVE WILKES BARRE PA 18711 (717) 826-7300 480 390272 VALLEY FORGE MED CENTER & HOSPITAL 1033 W GERMANTOWN PIKE NORRISTOWN PA 19401 (215) 539-8500 560 390275 CARON HOSPITAL BOX 277 GALEN HALL ROAD WERNERSVILLE PA 19565 (215) 678-2332 110 390278 EAGLEVILLE HOSPITAL 100 EAGLEVILLE RD EAGLEVILLE PA 19408 (215) 539-6000 560 390279 PHILIPSBURG AREA HOSPITAL 210 LOCH LOMOND ROAD PHILIPSBURG PA 16866 (814) 342-7112 200 390285 GRADUATE HOSPITAL ONE GRADUATE PLAZA PHILA PA 19146 (215) 893-2500 620 390286 BUCKS COUNTY HOSPITAL 225 NEWTOWN ROAD WARMINSTER PA 18974 (215) 441-6600 140 390287 MCP MEDICAL CENTER 3300 HENRY AVE PHILA PA 19129 (215) 842-6000 620 390289 ELKINS PARK HOSPITAL 60 EAST TOWNSHIP LINE ROAD ELKINS PARK PA 19027 (215) 663-6000 560 390290 HAHNEMANN UNIVERSITY HOSPITAL 230 NORTH BROAD STREET PHILADELPHIA PA 19102 (215) 762-7000 620 390291 ST FRANCIS HOSPITAL CRANBERRY ONE ST FRANCIS WAY CRANBERRY TWP PA 16066 (724) 772-5300 150 390300 SEMPERCARE HOSPITAL OF LANCASTER 555 NORTH DUKE STREET LANCASTER PA 17604 (972) 447-0281 440 391300 JERSEY SHORE HOSPITAL THOMPSON STREET JERSEY SHORE PA 17740 (570) 398-0100 510 391301 MUNCY VALLEY HOSPITAL 215 EAST WATER STREET MUNCY PA 17756 (570) 546-8282 510 391302 MEYERSDALE COMMUNITY HOSPITAL 200 HOSPITAL DRIVE MYERSDALE PA 15552 (814) 634-5911 680 391303 FULTON COUNTY MEDICAL CENTER 216 SOUTH FIRST STREET MCCONNELLSBURG PA 17233 (717) 485-3155 360 391304 BUCKTAIL MEDICAL CENTER 1001 PINE STREET RENOVO PA 17764 (570) 923-1000 240 391305 TROY COMMUNITY HOSPITAL 100 JOHN STREET TROY PA 16947 (570) 297-2121 130 392024 LIFECARE HOSPITALS OF PITTSBURGH INC 225 PENN AVENUE PITTSBURGH PA 15221 (412) 247-2424 10 392025 MERCY SPECIAL CARE HOSPITAL 128 WEST WASHINGTON STREET NANTICOKE PA 18634 (717) 735-5000 480 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 113 Provider ID Hospital Name Address City State ZIP Telephone County 392026 GIRARD MEDICAL CENTER EIGHTH STREET AND GIRARD AVENUE PHILADELPHIA PA 19122 (215) 787-9009 620 392027 KINDRED HOSPITAL PHILADELPHIA 6129 PALMETTO STREET PHILADELPHIA PA 19111 (215) 722-8555 640 392028 KINDRED HOSPITAL - PITTSBURGH 7777 STEUBENVILLE PIKE OAKDALE PA 15071 (412) 494-5500 10 392029 SELECT SPECIALTY HOSPITAL O PITTSBURGH 1400 LOCUST STREET PITTSBURGH PA 15219 (412) 485-4500 10 392031 SELECT SPECIALTY HOSPITAL OF JOHNSTOWN 1086 FRANKLIN STREET 6TH FLOOR JOHNSTOWN PA 15905 (814) 534-5000 160 392032 KINDRED HOSPITAL - DELAWARE COUNTY 1500 LANSDOWNE AVE 6TH FLOOR DARBY PA 19023 (215) 456-6090 620 392033 GOOD SHEPHERD SPECIALTY HOSPITAL 1ST FLOOR, ANDERSON WING, CEDAR CRESALLENTOWN PA 18105 (610) 402-8962 470 392034 SCCI HOSPITAL EASTON 250 SOUTH 21ST STREET EASTON PA 18042 (610) 250-4000 590 392035 SCCI HOSPITAL HARRISBURG 2601 NORTH THIRD STREET HARRISBURG PA 17110 (717) 213-9944 280 392036 SELECT SPECIALTY HOSPITAL OF GREENSBRG 532 WEST PITTSBURGH STREET GREENSBURG PA 15601 (724) 830-8649 770 392037 SELECT SPECIALTY HOSPITAL ERIE 201 STATE STREET ERIE PA 16550 (814) 877-2774 320 392038 HEALTHSOUTH REHAB HOSP FOR SPECIAL SVS 4950 WILSON LANE MECHANICSBURG PA 17055 (717) 697-7706 270 392039 SELECT SPECIALTY HOSPITAL CTR PA (CP) 503 NORTH 21ST STREET, FIFTH FLOOR CAMP HILL PA 17011 (717) 972-4560 280 393025 BRYN MAWR REHABILITATION HOSPITAL 414 PAOLI PIKE MALVERN PA 19355 (610) 251-5400 210 393026 HEALTHSOUTH REHAB HOSPITAL OF READING 1623 MORGANTOWN ROAD READING PA 19607 (610) 796-6000 110 393027 HEALTHSOUTH HARMARVILLE REHAB PO BOX 11460, GUYS RUN ROAD PITTSBURGH PA 15238 (412) 826-4922 510 393030 ALLIED SERVICES INST OF REHAB MEDICINE 475 MORGAN HIGHWAY P O BOX 1103 SCRANTON PA 18508 (570) 348-1300 420 393031 HEALTHSOUTH OF MECHANICSBURG 175 LANCASTER BLVD MECHANICSBURG PA 17055 (717) 691-3700 270 393032 CHESTNUT HILL REHAB HOSP 8601 STENTON AVE PHILADELPHIA PA 19118 (215) 233-6200 620 393035 GOOD SHEPHERD REHABILITATION HOSPITAL FIFTH AND ST JOHN STREETS ALLENTOWN PA 18103 (215) 776-3299 470 393036 JOHN HEINZ INST OF REHAB MEDICINE 99 MUNDY ST WILKES BARRE PA 18703 (717) 826-3800 680 393037 HEALTHSOUTH REHABILITATION HOSP YORK 1850 NORMANDIE DRIVE YORK PA 17404 (717) 767-6941 800 393038 MAGEE REHABILITATION HOSPITAL SIX FRANKLIN PLAZA PHILADELPHIA PA 19102 (215) 587-3000 620 393039 HEALTHSOUTH NITTANY VALLEY REHAB 550 WEST COLLEGE AVENUE PLEASANT GAP PA 16823 (814) 359-3421 200 393040 HEALTHSOUTH REHABILITATION HOSP ALTOON 2005 VALLEY VIEW BOULEVARD ALTOONA PA 16602 (814) 944-3535 120 393042 UPMC REHABILITATION HOSPITAL 1405 SHADY AVENUE PITTSBURGH PA 15217 (412) 420-2345 10 393043 HEALTHSOUTH GREATER PITTSBURGH REHAB 2380 MCGINLEY RD MONROEVILLE PA 15146 (412) 856-2400 10 393045 HEALTHSOUTH REHAB HOSPITL OF SEWICKLEY 303 CAMP MEETING ROAD SEWICKLEY PA 15143 (412) 741-9500 10 393046 HEALTHSOUTH REHAB HOSP OF ERIE 143 EAST SECOND STREET ERIE PA 16507 (814) 878-1200 320 393047 PENN STATE - GEISINGER REHAB HOSP 100 NORTH ACADEMY AVENUE DANVILLE PA 17822 (717) 271-6110 580 393302 CHILDRENS HOSP OF PITTSBURGH 125 DESOTO ST PITTSBURGH PA 15213 (412) 647-5012 10 393303 CHILDREN'S HOSPITAL OF PHILADELPHIA 34TH ST & CIVIC CENTER BLVD PHILADELPHIA PA 19104 (215) 590-3745 620 393304 CHILDREN'S HOME OF PITTSBURGH 5618 KENTUCKY AVENUE PITTSBURGH PA 15232 (412) 441-4884 10 393306 TEMPLE UNIVERSITY CHILDREN'S MED CNTR 3509 NORTH BROAD STREET PHILADELPHIA PA 19140 (215) 707-6000 620 393307 ST CHRISTOPHER'S HOSPITAL FOR CHILDREN 3601 A STREET PHILADELPHIA PA 19133 (215) 427-5337 620 393308 CHILDREN'S INSTITUTE 6301 NORTHUMBERLAND STREET PITTSBURGH PA 15217 (412) 420-2400 10 394001 NORRISTOWN STATE HOSPITAL 1001 STERIGERE STREET NORRISTOWN PA 19401 (610) 313-1015 560 394004 DANVILLE STATE HOSP 200 STATE HOSPITAL DRIVE DANVILLE PA 17821 (570) 271-4500 580 394006 NORTHWESTERN INSTITUTE OF PHYCHIATRY 450 BETHLEHEM PIKE FORT WASHINGTON PA 19034 (215) 641-5300 560 394007 KIRKBRIDE CENTER 111 N 49TH ST PHILADELPHIA PA 19139 (215) 471-2000 620 394008 FRIENDS HOSPITAL 4641 ROOSEVELT BOULEVARD PHILADELPHIA PA 19124 (215) 831-4600 620 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 114 Provider ID Hospital Name Address City State ZIP Telephone County 394010 HARRISBURG STATE HOSPITAL CAMERON & MACLAY STREETS, PO BOX 612 HARRISBURG PA 17106 (717) 772-7555 280 394011 ALLENTOWN STATE HOSPITAL 1600 HANOVER STREET ALLENTOWN PA 18109 (610) 740-3401 470 394012 CLARKS SUMMIT STATE HOSP 1451 HILLSIDE DR CLARKS SUMMIT PA 18411 (717) 586-2011 420 394014 WERNERSVILLE STATE HOSPITAL P O BOX 300 WERNERSVILLE PA 19565 (610) 678-3411 110 394016 WARREN STATE HOSP 33 MAIN DRIVE WARREN PA 16365 (814) 723-5500 740 394018 MAYVIEW STATE HOSPITAL 1601 MAYVIEW ROAD BRIDGEVILLE PA 15017 (412) 257-6500 10 394020 PHILHAVEN HOSP 283 S BUTLER ROAD PO BOX 550 MT GRETNA PA 17064 (717) 273-8871 460 394023 BELMONT CENTER FOR COMPREHENSIVE TREAT 4200 MONUMENT AVENUE PHILADELPHIA PA 19131 (215) 877-2000 620 394026 TORRANCE STATE HOSP PO BOX 111 TORRANCE PA 15779 (412) 459-4511 770 394027 FAIRMOUNT BEHAVIORAL HEALTH SYSTEM 561 FAIRTHORNE AVENUE PHILADELPHIA PA 19128 (215) 487-4000 620 394031 EUGENIA HOSP INC 660 THOMAS RD LAFAYETTE HILL PA 19444 (215) 836-7700 560 394033 MONTGOMERY CO MH/MR EMERG SERV BLDG 16 STANBRIDGE STERIGERE ST NORRISTOWN PA 19401 (215) 279-6100 560 394034 HORSHAM CLINIC, INC 722 EAST BUTLER PIKE AMBLER PA 19002 (215) 643-7800 560 394038 DELAWARE VALLEY MENTAL HLTH FOUNDATION 833 BUTLER AVE DOYLESTOWN PA 18901 (215) 345-0444 140 394039 FIRST HOSPITAL WYOMING VALLEY 149 DANA ST WILKES BARRE PA 18702 (570) 552-3977 480 394040 MEADOWS PSYCHIATRIC CENTER 132 MEADOWS DRIVE CENTRE HALL PA 16828 (814) 364-2161 200 394043 CLARION PSYCH CNTR TWO HOSPITAL DR RD#3 BOX 188 CLARION PA 16214 (814) 226-9545 220 394047 NATIONAL HOSPITAL FOR KIDS IN CRISES 5300 KIDSPEACE DRIVE OREFIELD PA 18069 (610) 799-8800 470 400001 ASHFORD PRESBYTERIAN COMMUNITY HOSP PO BOX 32 SAN JUAN PR 902 (809) 721-2160 640 400002 ST LUKES EPISCOPAL HOSPITAL PO BOX 2027 PONCE PONCE PR 731 (809) 840-4545 560 400003 CLINICA DR PILA PO BOX 1910 LAS AMERICAS AVE PONCE PR 731 (787) 848-5600 560 400004 DEL MAESTRO HOSPITAL PO BOX 4708 SAN JUAN PR 936 (809) 758-8383 640 400005 FONT MARTELLO HOSPITAL BOX 639 HUMACAO PR 792 (809) 852-2424 340 400006 DOCTORS HOSPITAL P O BOX 11338 SANTURCE PR 907 (809) 724-2950 640 400007 RYDER MEMORIAL HOSPITAL CALL BOX 489 HUMACAO PR 792 (809) 852-0768 340 400009 SANTA ROSA CLINIC PO BOX 988 GUAYAMA PR 784 (809) 864-0101 280 400010 CASTANER GENERAL HOSPITAL PO BOX 1003 CASTANER PR 631 (809) 829-5010 400 400011 HOSPITAL DR DOMINGUEZ 300 FONT MARTELLO STREET HUMACAO PR 792 (809) 852-0505 340 400012 DR I GONZALEZ MARTINEZ ONCOLOGY HOSP BOX 1811 CENTRO MEDICO SAN JUAN PR 919 (809) 863-4149 640 400013 HOSPITAL MENONITA DE CAYEY PO BOX 967 CAYEY PR 737 (809) 738-2181 170 400014 BELLA VISTA HOSPITAL BOX 1750 MAYAGUEZ PR 680 (809) 834-2350 480 400015 SAN JUAN MUNICIPAL HOSPITAL CENTRO MEDICO, BOX 21405 RIO PIEDRAS PR 928 (809) 765-9995 640 400016 AUXILIO MUTUO HOSPITAL PONCE DE LEON AVENUE STOP 36 1/2 HATO REY PR 919 (809) 758-2000 640 400017 SAN CARLOS GENERAL HOSPITAL 1822 PONCE DE LEON AVE SANTURCE PR 909 (809) 727-5858 640 400018 MENNONITE GENERAL HOSPITAL INC PO BOX 1379 AIBONITO PR 705 (809) 735-8001 50 400019 PAVIA HOSPITAL PO BOX 11137 SANTURCE PR 909 (809) 727-6060 640 400021 HOSPITAL DE LA CONCEPCION 41 LUNA ST, BOX 285 SAN GERMAN PR 683 (809) 892-1860 630 400022 SANTO ASILO DE DAMAS HOSPITAL PONCE BY PASS PONCE PR 731 (809) 840-8686 560 400024 CLINICA ESPANOLA INC BOX 490 LA QUINTA MAYAGUEZ PR 681 (809) 832-2094 480 400026 LAFAYETTE HOSPITAL BOX 207 ARROYO PR 714 (809) 839-3232 80 400028 CLINICA ONCOLOGICA TERRENOS CENTRO MEDICO BARRIO MACH PONCE PR 731 (809) 843-0800 560 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 115 Provider ID Hospital Name Address City State ZIP Telephone County 400031 HUMACAO AREA HOSPITAL BOX 115 HUMACAO PR 791 (787) 852-2727 340 400032 HOSPITAL HERMANOS MELENDEZ P O BOX 306 BAYAMON PR 960 (809) 785-6715 110 400044 ST LUKE'S EPISCOPAL HOSPITAL BO MACHUELO PONCE PR 731 (809) 844-2080 560 400048 GUAYAMA AREA HOSPITAL PO BOX 910 GUAYAMA PR 784 (809) 864-4300 280 400061 UNIVERSITY DISTRICT HOSPITAL BARRIO MONACILLOS RIO PIEDRAS PR 935 (787) 754-0101 640 400079 AGUADILLA REGIONAL HOSPITAL BO CAMASEYES PO BOX 3968 AGUADILLA PR 603 (809) 891-0972 30 400087 HOSP REGIONAL DR CAYETANO COLL Y TOSTE BOX 9976 COTTO STATION ARECIBO PR 613 (809) 878-7272 70 400098 HOSPITAL SAN FRANCISCO 371 DE DIEGO AVE RIO PIEDRAS PR 923 (809) 767-5100 640 400102 HOSPITAL MATILDE BRENES 9 J STREET EXT HERMANAS DAVILA BAYAMON PR 960 (787) 786-6315 110 400103 DR RAMON EMETERIO BETANCES ROAD TWO KM 157 MAYAGUEZ PR 680 (809) 832-8686 480 400104 SAN JUAN BAUTISTA MEDICAL CENTER CARR 172 URB TURABO GARDENS CAGUAS PR 725 (809) 744-2500 130 400105 HOSPITAL UNIVERSITARIO DR RUIZ ARNAU LAUREL AVE SANTA JUANITA BAYAMON PR 956 (809) 787-0179 110 400106 METROPOLITAN HOSPITAL BOX 11981 SAN JUAN PR 922 (809) 783-6200 640 400109 SAN PABLO HOSPITAL 70 SANTA CRUZ ST, BOX 236 BAYAMON PR 960 (809) 786-7474 110 400110 HOSPITAL DR TITO MATTEI ROAD 128 PO BOX 68 YAUCO PR 698 (809) 856-2050 770 400111 HOSPITAL SAN CARLOS BORROMEO RD 110 KM 12 2 MOCA PR 676 (809) 877-8000 490 400112 CAROLINA AREA HOSPITAL AVE 65TH INFANTERIA BOX 3747 CAROLINA PR 985 (809) 757-1800 150 400113 HOSPITAL SAN CRISTOBAL CARR 506 BO COTO LAUREL PR 780 (809) 848-2100 560 400114 DR ALEJANDRO OTERO LOPEZ HOSPITAL CALLE HERNANDEZ CARRION 668 MANATI PR 674 (809) 854-3700 450 400115 HOSPITAL WILMA N VAZQUEZ CALLE BX 7001 VEGA BAJA PR 694 (809) 858-1580 720 400117 HOSPITAL DR SUSONI INC 55 PALM ST PO BOX 1298 ARECIBO PR 613 (809) 878-1010 70 400118 DOCTORS CENTER HOSPITAL PO BOX 532 MANATI PR 674 (809) 854-3372 450 400120 HOSPITAL INTERAMERICANO DE MEDICINA PO BOX 1744 CAGUAS PR 725 (809) 743-3434 130 400121 HOSPITAL SAN GERARDO ROAD NO 844 KM 0 5 PO CUPEY BAJO RIO PIEDRAS PR 928 (809) 761-8383 640 400122 HOSPITAL SAN AGUSTIN INC BOX 991 MANATI PR 674 (809) 854-2091 450 400123 CLINICA DR PEREA, INC BOX 170 MAYAGUEZ PR 681 (809) 834-0101 480 400124 CENTRO CARDIOVASCULAR CENTRO MEDICO BOX 366528 RIO PIEDRAS PR 928 (809) 754-8500 640 400125 HOSPITAL SAN PABLO DEL ESTE PO BOX 1028 FAJARDO PR 738 (787) 863-0505 260 400126 HOSPITAL METROPOLITANO SAN GERMAN CALLE JAVILLA AL COSTADO PARQUE DE BOSAN GERMAN PR 683 (787) 892-5300 630 400127 ADMIN DE SERVICIOS MEDICOS PUERTO RIC MONACILLO WARD BUILDING # 1 SAN JUAN PR 922 (787) 777-3400 640 403025 HEALTHSOUTH REHABILITATION HOSPITAL UNIVERSITY DISTRICT HOSPITAL -- 3RD FLORIO PIEDRAS PR 935 (787) 274-5100 640 403301 UNIVERSITY PEDIATRIC HOSPITAL PO BOX 191079 SAN JUAN PR 919 (809) 754-3700 640 404002 MEPSI CENTER RD NUM 2 KM 8 2 BAYAMON PR 956 (787) 793-3030 110 404004 FIRST HOSPITAL PANAMERICANO BOX 6425 CIDRA PR 739 (787) 739-5555 200 404005 SAN JUAN CAPESTRANO PSYCHIATRIC HOSP CARR 877 KM 1 6 CAMINO LAS LOMAS RR2 RIO PIEDRAS PR 928 (787) 760-0222 640 404006 HOSP PSIQUIATRIA DR RAMON FERNANDEZ BO MONACILLOS CAPARRA PR 922 (787) 759-8132 640 410001 MEMORIAL HOSPITAL OF RHODE ISLAND PROSPECT ST PAWTUCKET RI 2860 (401) 729-2322 30 410004 ROGER WILLIAMS HOSPITAL 825 CHALKSTONE AVE PROVIDENCE RI 2908 (401) 456-2000 30 410005 ST JOSEPH HEALTH SERVICES OF RI 200 HIGH SERVICE AVE NORTH PROVIDENCE RI 2904 (401) 456-3311 30 410006 NEWPORT HOSPITAL FREINDSHIP ST NEWPORT RI 2840 (401) 846-6400 20 410007 RHODE ISLAND HOSPITAL 593 EDDY ST PROVIDENCE RI 2902 (401) 277-4000 30 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 116 Provider ID Hospital Name Address City State ZIP Telephone County 410008 SOUTH COUNTY HOSPITAL INC 95 KENYON AVE WAKEFIELD RI 2879 (401) 782-8000 50 410009 KENT COUNTY MEMORIAL HOSPITAL 455 TOLL GATE RD WARWICK RI 2886 (401) 737-7000 10 410010 WOMEN AND INFANTS HOSPITAL OF RI 101 DUDLEY STREET PROVIDENCE RI 2905 (401) 274-1100 30 410011 LANDMARK MEDICAL CENTER INC 115 CASS AVE WOONSOCKET RI 2895 (401) 769-2200 30 410012 MIRIAM HOSPITAL 164 SUMMIT AVE PROVIDENCE RI 2906 (401) 331-8500 30 410013 WESTERLY HOSPITAL WELLS ST WESTERLY RI 2891 (401) 596-6000 50 412001 ELEANOR SLATER HOSPITAL BOX 8269 CRANSTON RI 2921 (401) 464-3666 30 413025 REHAB HOSP OF R I EDDIE DOWLING HIGHWAY NORTH SMITHFIELD RI 2896 (401) 766-0800 30 414000 BUTLER HOSPITAL 345 BLACKSTONE BLVD PROVIDENCE RI 2906 (401) 455-6270 30 414003 EMMA PENDLETON BRADLEY HOSPITAL 1011 VETERANS MEMORIAL PARKWAY RIVERSIDE RI 2915 (401) 434-3400 30 420002 PIEDMONT MEDICAL CENTER 222 S HERLONG AVE ROCK HILL SC 29730 (803) 329-1234 450 420004 MEDICAL UNIVERSITY HOSPITAL 169 ASHLEY AV CHARLESTON SC 29425 (843) 792-2300 90 420005 ST EUGENE MEDICAL CENTER 301 E JACKSON ST DILLON SC 29536 (843) 774-7750 160 420006 CHARLESTON MEMORIAL HOSPITAL 326 CALHOUN ST CHARLESTON SC 29401 (843) 953-8302 90 420007 SPARTANBURG REGIONAL MEDICAL CENTER 101 E WOOD ST SPARTANBURG SC 29303 (864) 560-6000 410 420009 OCONEE MEMORIAL HOSPITAL 298 MEMORIAL DRIVE SENECA SC 29678 (864) 882-3351 360 420010 CAROLINA PINES REGIONAL MEDICAL CENTER 1304 W BOBO NEWSOM HWY HARTSVILLE SC 29550 (864) 339-2231 150 420011 CANNON MEMORIAL HOSPITAL 123 MEDICAL PARK DRIVE BOX 188 PICKENS SC 29671 (864) 878-4791 380 420014 FAIRFIELD MEMORIAL HOSPITAL HIGHWAY 321 BY-PASS BOX 620 WINNSBORO SC 29180 (803) 635-5548 190 420015 PALMETTO BAPTIST MED CTR EASLEY 200 FLEETWOOD DRIVE EASLEY SC 29640 (864) 855-7200 380 420016 BARNWELL COUNTY HOSPITAL PO BOX 588 BARNWELL SC 29812 (803) 259-1000 50 420018 PALMETTO HEALTH RICHLAND 5 RICHLAND MEDICAL PARK COLUMBIA SC 29203 (803) 434-7000 390 420019 CHESTER COUNTY HOSPITAL 1 MEDICAL PARK DRIVE CHESTER SC 29706 (803) 581-3151 110 420020 GEORGETOWN MEMORIAL HOSPITAL 606 BLACK RIVER RD DRAWER 1718 GEORGETOWN SC 29440 (843) 527-7000 210 420023 ST FRANCIS HOSPITAL 1 ST FRANCIS DR GREENVILLE SC 29601 (864) 255-1000 220 420026 PROVIDENCE HOSPITAL 2435 FOREST DR COLUMBIA SC 29204 (803) 256-5300 390 420027 ANDERSON AREA MEDICAL CENTER 800 N FANT ST ANDERSON SC 29621 (864) 261-1109 30 420030 COLLETON MEDICAL CENTER 501 ROBERTSON BOULEVARD WALTERBORO SC 29488 (843) 549-6371 140 420033 ALLEN BENNETT MEMORIAL HOSPITAL 313 MEMORIAL DR GREER SC 29651 (864) 848-8200 220 420036 SPRINGS MEMORIAL HOSPITAL 800 W MEETING ST LANCASTER SC 29720 (803) 286-1214 280 420037 HILLCREST HOSPITAL 729 SOUTH EAST MAIN STREET SIMPSONVILLE SC 29681 (864) 967-6100 220 420038 LAURENS COUNTY HOSPITAL US HWY 76 PO DRAWER 976 CLINTON SC 29325 (864) 833-9100 290 420039 WALLACE THOMSON HOSPITAL 322 W SOUTH ST PO DRAWER 789 UNION SC 29379 (864) 427-0351 430 420043 UPSTATE CAROLINA MEDICAL CENTER 1530 N LIMESTONE ST GAFFNEY SC 29340 (864) 487-4271 100 420048 KERSHAW COUNTY MEDICAL CENTER HAILE AND ROBERTS STREETS, BOX 7003 CAMDEN SC 29020 (803) 432-4311 270 420049 CONWAY HOSPITAL INC 300 SINGLETON RIDGE ROAD CONWAY SC 29526 (843) 347-8037 250 420051 MCLEOD REGIONAL MEDICAL CENTER 555 E CHEVES ST BOX 8700 FLORENCE SC 29506 (843) 777-2000 200 420053 NEWBERRY COUNTY MEMORIAL HOSPITAL 2669 KINARD ST PO BOX 497 NEWBERRY SC 29108 (803) 276-7570 350 420054 MARLBORO PARK HOSPITAL PO BOX 738 BENNETTSVILLE SC 29512 (843) 479-2881 340 420055 MARION COUNTY MEDICAL CENTER 2829 E HWY 76 PO BOX 1150 MARION SC 29571 (843) 431-2000 330 420056 BAMBERG COUNTY MEMORIAL HOSPITAL PO BOX 507 BAMBERG SC 29003 (803) 245-4321 40 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 117 Provider ID Hospital Name Address City State ZIP Telephone County 420057 WILSON MEDICAL CENTER 701 CASHUA FERRY ROAD DARLINGTON SC 29540 (843) 395-1100 150 420059 WILLIAMSBURG REGIONAL HOSPITAL 500 NELSON BLVD KINGSTREE SC 29556 (843) 355-8888 440 420061 ABBEVILLE COUNTY MEMORIAL HOSPITAL PO BOX 887 ABBEVILLE SC 29620 (864) 459-5011 0 420062 CHESTERFIELD GENERAL HOSPITAL HIGHWAY 9 BOX 151 CHERAW SC 29520 (843) 537-7881 120 420064 LORIS COMMUNITY HOSPITAL 3655 MITCHELL ST LORIS SC 29569 (843) 716-7000 250 420065 BON SECOURS-ST FRANCIS XAVIER HOSPITAL 2095 HENRY TECKLENBURG DRIVE CHARLESTON SC 29414 (843) 402-1001 90 420066 CAROLINAS HOSPITAL SYSTEM LAKE CITY 258 N RON MCNAIR BLVD LAKE CITY SC 29560 (843) 394-2036 200 420067 BEAUFORT MEMORIAL HOSPITAL 955 RIBAUT RD BEAUFORT SC 29902 (843) 522-5200 60 420068 TRMC OF ORANGEBURG & CALHOUN 3000 ST MATTHEWS RD BOX 1806 ORANGEBURG SC 29115 (803) 533-2200 370 420069 CLARENDON MEMORIAL HOSPITAL 10 HOSPITAL ST BOX 550 MANNING SC 29102 (803) 435-8463 130 420070 TUOMEY 129 N WASHINGTON ST SUMTER SC 29150 (803) 778-8616 420 420071 SELF REGIONAL HEALTHCARE 1325 SPRING STREET GREENWOOD SC 29646 (864) 227-4111 230 420072 HAMPTON REGIONAL MEDICAL CENTER 503 CAROLINA AVE WEST VARNVILLE SC 29944 (803) 943-2771 240 420073 LEXINGTON MEDICAL CENTER 2720 SUNSET BLVD WEST COLUMBIA SC 29169 (803) 791-2000 310 420075 EDGEFIELD COUNTY HOSPITAL PO BOX 590 EDGEFIELD SC 29824 (803) 637-3174 180 420078 GREENVILLE HOSPITAL CENTER 701 GROVE RD GREENVILLE SC 29605 (864) 455-7000 220 420079 TRIDENT MEDICAL CENTER 9330 MEDICAL PLAZA DR CHARLESTON SC 29406 (843) 797-7000 90 420080 HILTON HEAD HOSPITAL 25 HOSPITAL CENTER BLVD HILTON HEAD ISLAND SC 29925 (843) 681-6122 60 420081 NORTH GREENVILLE HOSPITAL 807 N MAIN ST TRAVELERS REST SC 29690 (864) 834-5132 220 420082 AIKEN REGIONAL MEDICAL CENTER 202 UNIVERSITY PARKWAY AIKEN SC 29801 (803) 641-5000 10 420083 MARY BLACK MEMORIAL HOSPITAL 1700 SKYLYN DR BOX 3217 SPARTANBURG SC 29304 (864) 573-3000 410 420085 GRAND STRAND REG MED CENTER 809 82ND PARKWAY BOX 7500 MYRTLE BEACH SC 29577 (843) 692-1100 250 420086 PALMETTO HEALTH BAPTIST TAYLOR AT MARION COLUMBIA SC 29220 (803) 296-5172 390 420087 ROPER HOSPITAL 316 CALHOUN ST CHARLESTON SC 29401 (843) 724-2000 90 420089 EAST COOPER REGIONAL MEDICAL CENTER 1200 JOHNNIE DODDS BLVD MOUNT PLEASANT SC 29464 (843) 881-4311 90 420091 CAROLINAS HOSPITAL SYSTEM 805 PAMPLICO HWY BOX 100550 FLORENCE SC 29505 (843) 674-5000 200 420093 B J WORKMAN MEMORIAL HOSPITAL 751 E GEORGIA STREET WOODRUFF SC 29388 (864) 560-9291 410 420096 INTERMEDICAL HOSPITAL OF SC TAYLOR AT MARION STREET COLUMBIA SC 29220 (803) 296-3097 390 420097 REGENCY HOSPITAL OF SOUTH CAROLINA 121 EAST CEDAR STREET FLORENCE SC 29505 (843) 661-3489 200 421300 ALLENDALE COUNTY HOSPITAL 1787 ALLENDALE FAIRFAX RD FAIRFAX SC 29827 (803) 632-3311 20 422004 SPARTANBURG HOSP FOR RESTORATIVE CARE 389 SERPENTINE DR SPARTANBURG SC 29303 (864) 560-3235 110 422005 SPECIALTY HOSPITAL OF SOUTH CAROLINA 326 CALHOUN STREET THIRD FLOOR CHARLESTON SC 29401 (843) 953-8513 90 422006 INTERMEDICAL HOSPITAL OF SC TAYLOR AT MARION STREET BAPTIST MEDICAL CENTSC 29220 (803) 296-3097 390 423025 HEALTHSOUTH REHAB HOSP OF COLUMBIA 2935 COLONIAL DR COLUMBIA SC 29203 (803) 254-7777 390 423026 HEALTHSOUTH REHAB HOSP OF FLORENCE 900 EAST CHEVES STREET FLORENCE SC 29506 (843) 679-9000 200 423027 HEALTHSOUTH REHAB HOSP OF CHARLESTON 9181 MEDCOM DRIVE N CHARLESTON SC 29406 (803) 820-7777 170 423028 HEALTHSOUTH REHABILITAITON HOSPITAL 1795 FRANK GASTON BOULEVARD ROCK HILL SC 29732 (803) 326-3500 450 424003 WILLIAM S HALL PSYCHIATRIC INSTITUTE 1800 COLONIAL DRIVE COLUMBIA SC 29292 (803) 898-1725 390 424005 G WERBER BRYAN PSYCH HOSP 220 FAISON DR COLUMBIA SC 29203 (803) 935-7143 390 424006 PALMETTO LOWCOUNTRY BEHAVIORAL HEALTH 2777 SPEISSEGGER DRIVE CHARLESTON SC 29405 (843) 747-5830 90 424007 SPRINGBROOK BEHAVIORAL HEALTHCARE ONE HAVENWOOD LANE PO BOX 1005 TRAVELERS REST SC 29690 (864) 834-8013 220 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 118 Provider ID Hospital Name Address City State ZIP Telephone County 424008 THREE RIVERS BEHAVIORAL HEALTHCARE LLC 2900 SUNSET BOULEVARD WEST COLUMBIA SC 29169 (803) 796-9911 310 424010 CAROLINA CTR FOR BEHAVIORAL HEALTH,THE 2700 E PHILLIPS RD GREER SC 29650 (864) 235-2335 220 424011 PATRICK B HARRIS PSYCHIATRIC HOSPITAL 130 HIGHWAY 252 ANDERSON SC 29622 (803) 231-2600 30 430005 PRAIRIE LAKES HOSP & CARE CTR 400 10TH AVENUE NW WATERTOWN SD 57201 (605) 882-7000 140 430007 MADISON COMMUNITY HOSPITAL 917 N WASHINGTON AVE MADISON SD 57042 (605) 256-6551 390 430008 BROOKINGS HOSPITAL 300 22ND AVE BROOKINGS SD 57006 (605) 696-9000 50 430011 HURON REGIONAL MEDICAL CENTER 172 FOURTH STREET SE HURON SD 57350 (605) 353-6200 20 430012 AVERA SACRED HEART HOSPITAL 501 SUMMIT YANKTON SD 57078 (605) 668-8000 670 430013 AVERA QUEEN OF PEACE 525 N FOSTER MITCHELL SD 57301 (605) 995-2000 170 430014 AVERA ST LUKES 305 S STATE ST ABERDEEN SD 57401 (605) 622-5000 60 430015 ST MARYS HOSPITAL 800 E DAKOTA PIERRE SD 57501 (605) 224-3100 320 430016 AVERA MCKENNAN HOSP&UNIVERSITY HLTH CT 800 E 21ST ST SIOUX FALLS SD 57117 (605) 322-8000 490 430018 MID-DAKOTA HOSPITAL 300 S BYRON BLVD CHAMBERLAIN SD 57325 (605) 734-5511 70 430023 DELLS AREA HEALTH CENTER - AVERA 909 N IOWA AVE DELL RAPIDS SD 57022 (605) 428-5431 490 430024 DESMET MEMORIAL HOSP 306 PRAIRIE AVENUE SW DE SMET SD 57231 (605) 854-3329 380 430027 SIOUX VALLEY HOSPITAL 1100 S EUCLID AVE SIOUX FALLS SD 57117 (605) 333-4572 490 430029 SIOUX VALLEY VERMILLION HOSPITAL 20 SOUTH PLUM VERMILLION SD 57069 (605) 624-2611 130 430031 HAND COUNTY MEM HOSPITAL 300 W FIFTH STREET MILLER SD 57362 (605) 853-2421 290 430032 MEMORIAL CARE UNIT 400 10TH AVENUE NW WATERTOWN SD 57201 (605) 882-7000 140 430033 AVERA ST BENEDICT HEALTH CENTER 401 WEST GLYNN DRIVE PARKSTON SD 57366 (605) 928-3311 330 430043 WINNER REGIONAL HEALTHCARE CENTER 745 EAST 8TH ST WINNER SD 57580 (605) 842-2110 610 430047 AVERA GREGORY HEALTHCARE CENTER 400 PARK STREET GREGORY SD 57533 (605) 835-8394 260 430048 LOOKOUT MEMORIAL HOSPITAL 1440 N MAIN ST SPEARFISH SD 57783 (605) 644-4000 40 430054 CANTON-INWOOD MEMORIAL HOSPITAL 440 N HIAWATHA DRIVE CANTON SD 57013 (605) 987-2621 410 430060 HOLY INFANT HOSPITAL 512 MAIN STREET HOVEN SD 57450 (605) 948-2262 530 430064 COTEAU DES PRAIRIES HOSP 205 ORCHARD DR SISSETON SD 57262 (605) 698-7647 540 430077 RAPID CITY REGIONAL HOSPITAL 353 FAIRMONT BLVD RAPID CITY SD 57701 (605) 719-8100 510 430081 PHS INDIAN HOSPITAL PINE RIDGE - SHANNON PINE RIDGE SD 57770 (605) 867-5131 560 430082 IHS PHS INDIAN HOSPITAL 3200 CANYON LAKE DR RAPID CITY SD 57701 (605) 348-1900 510 430083 PHS IHS AT EAGLE BUTTE POST OFFICE BOX 1012 EAGLE BUTTE SD 57625 (605) 964-7724 200 430084 PHS INDIAN HOSPITAL PO BOX 400 ROSEBUD SD 57570 (605) 747-2231 600 430085 PHS INDIAN HOSPITAL POST OFFICE BOX 189 SISSETON SD 57262 (605) 698-7606 540 430089 SIOUXLAND SURGERY CENTER LP 600 SIOUX POINT RD DAKOTA DUNES SD 57049 (605) 232-3332 630 430090 SIOUX FALLS SURGICAL CENTER LLP 910 EAST 20TH STREET SIOUX FALLS SD 57105 (605) 334-6730 490 430091 BLACK HILLS SURGERY CENTER LLP 216 ANAMARIA DRIVE RAPID CITY SD 57701 (605) 388-9440 510 430092 DAKOTA PLAINS SURGICAL CENTER LLP 701 8TH AVENUE NW SUITE C ABERDEEN SD 57401 (605) 225-3300 60 430093 SAME DAY SURGERY CENTER LLC 651 CATHEDRAL DRIVE RAPID CITY SD 57701 (605) 719-5000 510 430094 SPEARFISH SURGERY CENTER 1316 10TH ST SPEARFISH SD 57783 (605) 642-3113 400 430095 HEART HOSPITAL OF SOUTH DAKOTA LLC 4500 W 69TH ST SIOUX FALLS SD 57108 (605) 977-7000 410 430096 LEWIS AND CLARK SPECIALTY HOSPITAL 2601 FOX RUN PARKWAY YANKTON SD 57078 (605) 665-5100 670 431301 FAULK COUNTY MEMORIAL HOSPITAL-CAH 911 ST JOHN STREET FAULKTON SD 57438 (605) 598-6262 240 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 119 Provider ID Hospital Name Address City State ZIP Telephone County 431302 GETTYSBURG MEMORIAL HOSPITAL-CAH 700 EAST GARFIELD GETTYSBURG SD 57442 (605) 765-2480 530 431303 FIVE COUNTIES HOSPITAL-CAH 405 SIXTH AVENUE WEST LEMMON SD 57638 (605) 374-3871 520 431305 DOUGLAS COUNTY MEMORIAL HOSPITAL-CAH 708 8TH ST ARMOUR SD 57313 (605) 724-2159 210 431306 PLATTE HEALTH CENTER - CAH 601 E 7TH ST PLATTE SD 57369 (605) 337-3364 110 431307 DEUEL COUNTY MEMORIAL HOSP &CLINIC-CAH 701 THIRD AVENUE SOUTH CLEAR LAKE SD 57226 (605) 874-2141 190 431308 EUREKA COMMUNITY HEALTH SERVICES-CAH E AVENUE & 9TH STREET EUREKA SD 57437 (605) 284-2661 440 431309 COMMUNITY MEMORIAL HOSPITAL-CAH 8TH & JACKSON BURKE SD 57523 (605) 775-2631 260 431310 FLANDREAU MUNICIPAL HOSPITAL-CAH 214 NORTH PRAIRIE AVENUE FLANDREAU SD 57028 (605) 997-2433 500 431311 LAKE AREA HOSPITAL-CAH NORTH FIRST STREET WEBSTER SD 57274 (605) 345-3336 180 431312 MARSHALL COUNTY HEALTHCARE CENTER-CAH 413 9TH STREET BRITTON SD 57430 (605) 448-2253 450 431313 FREEMAN COMMUNITY HOSPITAL-CAH 510 E 8TH ST FREEMAN SD 57029 (605) 925-4000 330 431314 BENNETT COUNTY HEALTHCARE CENTER-CAH 102 MAJOR ALLEN MARTIN SD 57551 (605) 685-6622 30 431315 WAGNER COMMUNITY MEMORIAL HOSPITAL-CAH THIRD & WALNUT WAGNER SD 57380 (605) 384-3611 110 431316 COMMUNITY MEMORIAL HOSPITAL - CAH 111 W 10TH AVE REDFIELD SD 57469 (605) 472-1110 570 431317 LANDMANN-JUNGMAN MEMORIAL HOSPITAL-CAH 600 BILLARS SCOTLAND SD 57059 (605) 583-2226 40 431318 BOWDLE HOSPITAL - CAH 8001 W 5TH BOWDLE SD 57428 (605) 285-6146 220 431319 HANS P PETERSON MEMORIAL HOSPITAL-CAH 503 W PINE PHILIP SD 57567 (605) 859-2511 270 431320 NORTHERN HILLS GENERAL HOSPITAL-CAH 61 CHARLES STREET DEADWOOD SD 57732 (605) 722-6101 400 431321 STURGIS COMMUNITY HEALTH CARE CTR-CAH 949 HARMON STREET STURGIS SD 57785 (605) 347-2536 460 431322 FALL RIVER HOSPITAL - CAH 209 N 16TH ST HOT SPRINGS SD 57747 (605) 745-3159 230 431323 CUSTER COMMUNITY HOSPITAL - CAH 1039 MONTGOMERY STREET CUSTER SD 57730 (605) 673-2229 160 431324 AVERA WESKOTA MEMORIAL MED CTR - CAH 604 1ST ST NE WESSINGTON SPRINGSSD 57382 (605) 539-1201 360 431325 MOBRIDGE REGIONAL HOSPITAL - CAH 1401 10TH AVE WEST MOBRIDGE SD 57601 (605) 845-3692 640 431326 ST BERNARDS PROVIDENCE HOSPITAL - CAH 901 E VIRGIL AVE MILBANK SD 57252 (605) 432-4538 250 431327 ST MICHAEL'S HOSPITAL - CAH 410 W 16TH AVE TYNDALL SD 57066 (605) 589-3341 40 431328 PIONEER MEMORIAL HOSPITAL - CAH 315 N WASHINGTON AVE VIBORG SD 57070 (605) 326-5161 620 432002 SELECT SPECIALTY HOSPITAL 800 E 21ST SUITE 3300 SIOUX FALLS SD 57105 (605) 322-3500 490 434003 SOUTH DAKOTA HUMAN SERVICES CENTER 3515 BROADWAY AVE YANKTON SD 57078 (605) 668-3100 670 440001 UNICOI COUNTY MEMORIAL HOSPITAL GREENWAY CIRCLE ERWIN TN 37650 (423) 743-3141 850 440002 JACKSON-MADISON COUNTY GEN HOSPITAL 708 W FOREST JACKSON TN 38301 (731) 425-5000 560 440003 SUMNER REGIONAL MEDICAL CENTER 555 HARTSVILLE PIKE GALLATIN TN 37066 (615) 452-4210 820 440006 SKYLINE MEDICAL CENTER 3441 DICKERSON PIKE NASHVILLE TN 37207 (615) 865-3511 180 440007 COFFEE MEDICAL CENTER 1001 MCARTHUR DR BOX 1079 MANCHESTER TN 37355 (931) 728-3586 150 440008 METHODIST HEALTHCARE LEXINGTON HOSP 200 W CHURCH ST LEXINGTON TN 38351 (901) 968-3646 380 440009 CUMBERLAND MEDICAL CENTER 421 S MAIN ST CROSSVILLE TN 38555 (931) 484-9511 170 440010 WAYNE MEDICAL CENTER 103 J V MANGUBAT DR WAYNESBORO TN 38485 (615) 722-5411 900 440011 BLOUNT MEMORIAL HOSPITAL 907 E LAMAR ALEXANDER PARKWAY MARYVILLE TN 37804 (865) 977-4778 40 440012 BRISTOL REGIONAL MEDICAL CENTER ONE MEDICAL PARK BLVD P O BOX 8964 BRISTOL TN 37621 (423) 844-1121 810 440015 UNIVERSITY OF TN MEMORIAL HOSPITAL 1924 ALCOA HIGHWAY KNOXVILLE TN 37920 (865) 544-9428 460 440016 BAPTIST MEMORIAL HOSPITAL HUNTINGDON 631 R B WILSON DR HUNTINGDON TN 38344 (731) 986-7202 80 440017 HOLSTON VALLEY MEDICAL CENTER 130 WEST RAVINE ROAD PO BOX 238 KINGSPORT TN 37662 (423) 224-4000 810 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 120 Provider ID Hospital Name Address City State ZIP Telephone County 440018 SYCAMORE SHOALS HOSPITAL 1501 WEST ELK AVENUE ELIZABETHTON TN 37643 (423) 542-1300 90 440019 BAPTIST HOSPITAL OF EAST TENNESSEE 137 BLOUNT AV BOX 1788 KNOXVILLE TN 37901 (865) 632-5011 460 440020 HILLSIDE HOSPITAL 1265 E COLLEGE ST PULASKI TN 38478 (931) 363-7531 270 440023 RHEA MEDICAL CENTER 7900 RHEA COUNTY HWY BOX 609 DAYTON TN 37321 (423) 775-1121 710 440024 BRADLEY MEMORIAL HOSPITAL 2305 N CHAMBLISS AVE, BOX 3060 CLEVELAND TN 37320 (423) 559-6000 50 440025 LAUGHLIN MEMORIAL HOSPITAL, INC 1420 TUSCULUM BLVD GREENEVILLE TN 37745 (423) 787-5000 290 440026 NASHVILLE REHAB HOSPITAL 610 GALLATIN RD NASHVILLE TN 37206 (615) 226-4330 180 440029 WILLIAMSON MEDICAL CENTER 2021 CAROTHERS RD BOX 681600 FRANKLIN TN 37068 (615) 791-2151 930 440030 MORRISTOWN HAMBLEN HOSPITAL ASSOC 908 W 4TH NORTH ST MORRISTOWN TN 37814 (423) 586-4231 310 440031 ROANE MEDICAL CENTER 412 DEVONIA ST HARRIMAN TN 37748 (865) 882-4381 720 440032 WELLMONT HAWKINS COUNTY MEMORIAL HOSP 851 LOCUST STREET ROGERSVILLE TN 37857 (423) 272-2671 360 440033 ST MARY'S MEDICAL CTR OF CAMPBELL CO 923 EAST CENTRAL AVENUE LA FOLLETTE TN 37766 (423) 562-2211 60 440034 METHODIST MED CENTER OF OAK RIDGE 990 OAK RIDGE TURNPIKE BOX 529 OAK RIDGE TN 37831 (865) 481-1000 0 440035 GATEWAY MEDICAL CENTER 1771 MADISON ST CLARKSVILLE TN 37043 (931) 551-1730 620 440039 VANDERBILT UNIVERSITY HOSPITAL 1211 22ND AVENUE SOUTH NASHVILLE TN 37232 (615) 322-5000 180 440040 PERRY COMMUNITY HOSPITAL 805 SQUIRREL HOLLOW DRIVE LINDEN TN 37096 (931) 589-2121 670 440041 COPPER BASIN MEDICAL CENTER HWY 68 P O BOX 990 COPPERHILL TN 37317 (423) 496-5511 690 440046 HORIZON MEDICAL CENTER 111 HIGHWAY 70 EAST DICKSON TN 37055 (615) 446-0446 210 440047 GIBSON GENERAL HOSPITAL 200 HOSPITAL DR TRENTON TN 38382 (901) 855-2551 260 440048 BAPTIST MEMORIAL HOSPITAL 6019 WALNUT GROVE ROAD MEMPHIS TN 38120 (901) 226-5000 780 440049 METHODIST HEALTHCARE MEMPHIS HOSPITALS 1265 UNION AVE MEMPHIS TN 38104 (901) 726-7000 780 440050 TAKOMA ADVENTIST HOSPITAL 401 TAKOMA AVE GREENEVILLE TN 37743 (423) 639-3151 290 440051 METHODIST HEALTHCARE-MCNAIRY HOSPITAL 705 E POPLAR AVE SELMER TN 38375 (901) 645-3221 540 440052 SCOTT COUNTY HOSPITAL HWY 27 BOX 308 ONEIDA TN 37841 (423) 569-8521 750 440053 MIDDLE TENNESSEE MEDICAL CENTER INC 400 N HIGHLAND AVE MURFREESBORO TN 37130 (931) 879-8171 740 440054 WOODS MEMORIAL HOSPITAL HWY 411 BOX 410 ETOWAH TN 37331 (423) 263-3600 530 440056 JEFFERSON MEMORIAL HOSPITAL 110 HOSPITAL DRIVE JEFFERSON CITY TN 37760 (865) 475-2500 440 440057 CLAIBORNE COUNTY HOSPITAL 1000 OLD KNOXVILLE HIGHWAY, PO BOX 219TAZEWELL TN 37879 (423) 626-4211 120 440058 SOUTHERN TENNESSEE MEDICAL CENTER 185 HOSPITAL ROAD WINCHESTER TN 37398 (931) 967-8295 250 440059 COOKVILLE REGIONAL MEDICAL CENTER 142 W 5TH ST COOKEVILLE TN 38501 (615) 528-2541 700 440060 MILAN GENERAL HOSPITAL 4039 SOUTH HIGHLAND MILAN TN 38358 (901) 686-1591 260 440061 METHODIST HEALTHCARE-VOLUNTEER HOSPITL 161 MOUNT PELIA RD MARTIN TN 38237 (901) 587-4261 910 440063 JOHNSON CITY MEDICAL CTR 400 N STATE OF FRANKLIN RD JOHNSON CITY TN 37604 (423) 431-6111 890 440064 GRANDVIEW MEDICAL CENTER 1000 HIGHWAY 28 JASPER TN 37347 (423) 837-9500 570 440065 NORTHCREST MEDICAL CENTER 100 NORTHCREST DRIVE SPRINGFIELD TN 37172 (615) 384-2411 730 440067 LAKEWAY REGIONAL HOSPITAL 726 MCFARLAND ST MORRISTOWN TN 37814 (423) 586-2302 310 440068 ATHENS REGIONAL MEDICAL CENTER 1114 WEST MADISON AVENUE ATHENS TN 37303 (423) 745-1411 530 440070 DECATUR COUNTY GENERAL HOSPITAL 1200 TENNESSEE ST S BOX 250 PARSONS TN 38363 (901) 847-3031 190 440072 METHODIST HEALTHCARE DYERSBURG HOSPITA 400 TICKLE ST DYERSBURG TN 38024 (731) 285-2410 220 440073 MAURY REGIONAL HOSPITAL 1224 TROTWOOD AVE COLUMBIA TN 38401 (931) 381-1111 590 440081 FORT SANDERS SEVIER MEDICAL CENTER 709 MIDDLE CREEK RD SEVIERVILLE TN 37862 (423) 429-6100 170 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 121 Provider ID Hospital Name Address City State ZIP Telephone County 440082 ST THOMAS HOSPITAL 4220 HARDING RD, PO BOX 380 NASHVILLE TN 37205 (615) 222-6631 180 440083 JAMESTOWN REGIONAL MEDICAL CENTER 436 CENTRAL AVENUE WEST JAMESTOWN TN 38556 (931) 879-8171 240 440084 SWEETWATER HOSPITAL ASSOCIATION 304 WRIGHT ST SWEETWATER TN 37874 (423) 213-8200 610 440091 MEMORIAL HOSPITAL 2525 DESALES AVE CHATTANOOGA TN 37404 (423) 495-8490 320 440102 LINCOLN REGIONAL HOSPITAL 700 W MAPLE FAYETTEVILLE TN 37334 (931) 438-1100 510 440104 ERLANGER MEDICAL CENTER 975 EAST THIRD ST CHATTANOOGA TN 37403 (423) 778-7000 320 440105 JOHNSON CITY SPECIALTY HOSPITAL 203 E WATAUGA AVE JOHNSON CITY TN 37601 (423) 434-1400 890 440109 HARDIN COUNTY GENERAL HOSPITAL 2006 WAYNE RD SAVANNAH TN 38372 (901) 925-4954 350 440110 FORT SANDERS LOUDON MEDICAL CENTER VONORE RD BOX 217 LOUDON TN 37774 (865) 458-8222 520 440111 METRO NASHVILLE GENERAL HOSPITAL 1818 ALBION STREET NASHVILLE TN 37208 (615) 341-4000 180 440114 BAPTIST MEMORIAL HOSPITAL LAUDERDALE 326 ASBURY RD RIPLEY TN 38063 (731) 221-2409 480 440115 HUMBOLDT GENERAL HOSPITAL INC 3525 CHERE CAROL RD HUMBOLDT TN 38343 (901) 784-0301 260 440120 ST MARYS MEDICAL CENTER OAK HILL AVE KNOXVILLE TN 37917 (865) 545-8000 460 440125 FORT SANDERS REGIONAL MEDICAL CENTER 1901 CLINCH AVE KNOXVILLE TN 37916 (865) 541-1111 460 440130 BAPTIST MEMORIAL HOSPITAL UNION CITY 1201 BISHOP ST, PO BOX 310 UNION CITY TN 38261 (731) 885-2410 650 440131 BAPTIST MEMORIAL HOSPITAL TIPTON 1995 HWY 51 S BOX 737 COVINGTON TN 38019 (901) 476-2621 830 440132 HENRY COUNTY MEDICAL CENTER 301 TYSON AV PARIS TN 38242 (901) 642-1220 390 440133 BAPTIST HOSPITAL 2000 CHURCH ST NASHVILLE TN 37203 (615) 284-5555 180 440135 TENNESSEE CHRISTIAN MEDICAL CENTER 500 HOSPITAL DR MADISON TN 37115 (615) 865-2373 180 440137 BEDFORD COUNTY MEDICAL CENTER 845 UNION STREET SHELBYVILLE TN 37160 (931) 685-5433 10 440141 CUMBERLAND RIVER HOSPITAL 100 OLD JEFFERSON ST CELINA TN 38551 (931) 243-3581 130 440142 CARTHAGE GENERAL HOSPITAL PO BOX 319, 130 LEBANON HWY CARTHAGE TN 37030 (615) 735-9815 790 440143 MARSHALL MEDICAL CENTER 1080 N ELLINGTON PARKWAY LEWISBURG TN 37091 (615) 359-6241 580 440144 JOHN W HARTON REGIONAL MED CENTER 1801 N JACKSON ST BOX 460 TULLAHOMA TN 37388 (615) 393-3000 150 440145 CAMDEN GENERAL HOSPITAL 175 HOSPITAL DR CAMDEN TN 38320 (901) 584-6135 20 440147 BAPTIST REHABILITATION GERMANTOWN 2100 EXETER ROAD GERMANTOWN TN 38138 (901) 757-1350 780 440148 BAPTIST DEKALB GENERAL HOSPITAL 520 W MAIN ST SMITHVILLE TN 37166 (615) 597-7171 200 440149 TRINITY HOSPITAL 353 MAIN ST BOX 489 ERIN TN 37061 (615) 289-4211 410 440150 SUMMIT MEDICAL CENTER 5655 FRIST BLVD HERMITAGE TN 37076 (615) 316-3000 180 440151 RIVER PARK HOSPITAL 1559 SPARTA STREET MC MINNVILLE TN 37110 (931) 815-4000 880 440152 REGIONAL MEDICAL CENTER AT MEMPHIS 877 JEFFERSON AVENUE MEMPHIS TN 38103 (901) 545-7928 780 440153 BAPTIST HOSPITAL OF COCKE COUNTY 435 SECOND STREET NEWPORT TN 37821 (423) 625-2200 140 440156 PARKRIDGE MEDICAL CENTER 2333 MCCALLIE AVE CHATTANOOGA TN 37404 (423) 493-1290 320 440159 DELTA MEDICAL CENTER 3000 GETWELL RD MEMPHIS TN 38118 (901) 369-8100 780 440161 CENTENNIAL MEDICAL CENTER 2300 PATTERSON STREET NASHVILLE TN 37203 (615) 342-1000 180 440162 HEALTHSOUTH CHATTANOOGA REHAB HOSPITAL 2412 MCCALLIE AVE CHATTANOOGA TN 37404 (423) 698-0221 320 440166 UNIVERSITY OF TENNESSEE BOWLD HOSPITAL 951 COURT AV MEMPHIS TN 38103 (901) 448-4108 780 440168 METHODIST HEALTHCARE FAYETTE HOSPITAL 214 LAKEVIEW DR SOMERVILLE TN 38068 (901) 465-3594 230 440173 FORT SANDERS PARK WEST MED CTR 9352 PARK WEST BLVD KNOXVILLE TN 37923 (423) 693-5151 460 440174 METHODIST HEALTHCARE-BROWNSVILLE HOSP 2545 N WASHINGTON AVE BROWNSVILLE TN 38012 (901) 772-4110 370 440175 CROCKETT HOSPTIAL HWY 43 S BOX 847 LAWRENCEBURG TN 38464 (931) 762-6571 490 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 122 Provider ID Hospital Name Address City State ZIP Telephone County 440176 INDIAN PATH MEDICAL CENTER 2000 BROOKSIDE DR KINGSPORT TN 37660 (423) 857-7000 810 440180 JELLICO COMMUNITY HOSPITAL RT 1 BOX 197 JELLICO TN 37762 (423) 784-7252 60 440181 BOLIVAR GENERAL HOSPITAL 650 NUCKOLLS ROAD BOLIVAR TN 38008 (901) 658-3100 340 440182 METHODIST HEALTHCARE-MCKENZIE HOSPITAL 945 N HIGHLAND MC KENZIE TN 38201 (901) 352-5344 80 440183 ST FRANCIS HOSPITAL 5959 PARK AVE MEMPHIS TN 38119 (901) 765-1000 780 440184 NORTHSIDE HOSPITAL 401 PRINCETON RD JOHNSON CITY TN 37601 (423) 854-5600 890 440185 CLEVELAND COMMUNITY HOSPITAL 2800 WEST SIDE DR NW CLEVELAND TN 37312 (423) 339-4100 50 440186 SMITH COUNTY MEMORIAL HOSPITAL 158 HOSPITAL DRIVE CARTHAGE TN 37030 (615) 735-1560 790 440187 LIVINGSTON REGIONAL HOSPITAL 315 OAK ST BOX 550 LIVINGSTON TN 38570 (615) 823-5611 660 440189 METHODIST LEBONHEUR HEALTHCARE-JACKSON 367 HOSPITAL BLVD JACKSON TN 38305 (901) 661-2185 560 440192 WHITE COUNTY COMMUNITY HOSPITAL 401 SEWELL RD SPARTA TN 38583 (931) 738-9211 920 440193 UNIVERSITY MEDICAL CENTER 1411 BADDOUR PARKWAY LEBANON TN 37087 (615) 444-8262 940 440194 HENDERSONVILLE MEDICAL CENTER 355 NEW SHACKLE ISLAND RD HENDERSONVILLE TN 37075 (615) 264-0000 820 440197 SOUTHERN HILLS MEDICAL CTR 391 WALLACE RD NASHVILLE TN 37211 (615) 781-4000 180 440200 STONES RIVER HOSPITAL 324 DOOLITTLE ROAD WOODBURY TN 37190 (615) 563-4001 70 440203 MEDICAL CENTER OF MANCHESTER 481 INTERSTATE DRIVE BOX 1409 MANCHESTER TN 37355 (931) 728-6354 150 440210 WOMEN'S EAST PAVILION 1751 GUNBARREL ROAD CHATTANOOGA TN 37421 (423) 954-8700 320 440217 BAPTIST MEMORIAL HOSPITAL-COLLIERVILLE 1500 WEST POPLAR AVENUE COLLIERVILLE TN 38017 (901) 861-9000 780 440218 BAPTIST WOMENS PAVILION 2011 MURPHY AVENUE NASHVILLE TN 37203 (615) 284-2970 180 440222 BAPTIST MEMORIAL HOSPITAL FOR WOMEN 6225 HUMPHREYS BOULEVARD MEMPHIS TN 38120 (901) 227-9000 780 441300 BAPTIST HICKMAN COMMUNITY HOSPITAL 135 EAST SWAN STREET CENTERVILLE TN 37033 (931) 729-4271 400 441301 TROUSDALE MEDICAL CENTER 500 CHURCH STREET HARTSVILLE TN 37074 (615) 374-2221 840 441303 THREE RIVERS HOSPITAL 451 HIGHWAY 13 SOUTH WAVERLY TN 37185 (931) 296-4203 420 441304 JOHNSON COUNTY HEALTH CENTER 1901 S SHADY ST MOUNTAIN CITY TN 37683 (423) 727-1110 450 441305 MACON COUNTY GENERAL HOSPITAL 204 MEDICAL DRIVE LA FAYETTE TN 37083 (615) 666-2147 550 441306 ERLANGER BLEDSOE HOSPITAL HIGHWAY 30 W PIKEVILLE TN 37367 (423) 447-2112 30 442006 NASHVILLE METROPOLITAN BORDEAUX HOSP 1414 COUNTY HOSPITAL ROAD NASHVILLE TN 37218 (615) 862-7005 180 442007 KINDRED HOSPITAL - CHATTANOOGA 709 WALNUT STREET CHATTANOOGA TN 37402 (423) 266-7721 320 442010 BAPTIST MEMORIAL RESTORATIVE CARE HOSP 6019 WALNUT GROVE ROAD 1 WEST MEMPHIS TN 38120 (901) 227-0748 780 442011 SELECT SPECIALTY HOSPITAL NASHVILLE 2000 CHURCH STREET 4TH AND 5TH FLOORSNASHVILLE TN 37203 (615) 340-9100 180 442012 SELECT SPECIALTY HOSP KNOXVILLE 1901 CLINCH AVE FORTH FLOOR N KNOXVILLE TN 37916 (423) 541-2653 460 442013 METHODIST ALLIANCE EXTENDED CARE HOSP 225 SOUTH CLAYBROOK MEMPHIS TN 38104 (901) 726-2113 780 442014 SELECT SPECIALTY HOSPITAL MEMPHIS 5959 PARK AVENUE MEMPHIS TN 38119 (901) 765-1245 780 442015 SELECT SPECIALTY HOSPITAL-N KNOXVILLE 900 OAK HILL AVENUE-4TH FLOOR KNOXVILLE TN 37917 (423) 545-8526 460 442016 SELECT SPECIALTY HOSPITAL-TRICITIES ONE MEDICAL PARK BOULEVARD, 5TH FLOOBRISTOL TN 37620 (423) 968-1121 810 443025 SISKIN HOSP FOR PHYSICAL REHAB 1 SISKIN PLAZA CHATTANOOGA TN 37403 (423) 634-1200 320 443027 HEALTHSOUTH REHABILITATION HOSPITAL 113 CASSEL DRIVE KINGSPORT TN 37660 (423) 246-7240 810 443028 VANDERBILT STALLWORTH REHAB HOSP LP 2201 CAPERS AVENUE NASHVILLE TN 37212 (615) 320-7600 180 443029 HEALTHSOUTH REHABILITATION HOSPITAL 1282 UNION AVENUE MEMPHIS TN 38104 (901) 729-5104 780 443030 HEALTHSOUTH CANE CREEK REHAB HOSPITAL 180 PELIA ROAD MARTIN TN 38237 (731) 587-4231 910 443031 HEALTHSOUTH REHAB HOSP NORTH 4100 AUSTIN PEAY HIGHWAY MEMPHIS TN 38128 (901) 213-5400 780 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 123 Provider ID Hospital Name Address City State ZIP Telephone County 443302 ST JUDE CHILDRENS RESEARCH HOSP 332 NORTH LAUDERDALE ST MEMPHIS TN 38105 (901) 495-4564 780 443303 EAST TENNESSEE CHILDRENS HOSPITAL 2018 CLINCH AVE SW KNOXVILLE TN 37916 (865) 541-8181 460 444000 LAKESHORE MENTAL HLTH INSTITUTE 5908 LYONS VIEW PIKE KNOXVILLE TN 37919 (865) 584-1561 460 444001 MEMPHIS MENTAL HEALTH INSTITUTE 865 POPLAR AVE MEMPHIS TN 38174 (901) 524-1200 780 444002 MOCCASSIN BEND MENTAL HEALTH INSTITUTE 100 MOCCASIN BEND ROAD CHATTANOOGA TN 37405 (423) 785-3329 320 444003 RIDGEVIEW PSYCHIATRIC HOSP AND CENTER 240 W TYRONE RD OAK RIDGE TN 37830 (865) 482-1076 0 444004 LAKESIDE BEHAVIORAL HEALTH SYSTEM 2911 BRUNSWICK RD MEMPHIS TN 38133 (901) 377-4797 780 444006 WOODRIDGE HOSP 403 STATE OF FRANKLIN RD JOHNSON CITY TN 37601 (615) 928-7111 890 444008 WESTERN MENTAL HEALTH INSTITUTE HWY 64 BOLIVAR TN 38074 (901) 658-5141 340 444010 PATHWAYS OF TENNESSEE, INC 238 SUMMAR DR JACKSON TN 38301 (901) 935-8200 560 444014 MIDDLE TN MENTAL HEALTH INSTITUTE 221 STEWARTS FERRY PIKE NASHVILLE TN 37214 (615) 902-7565 180 444016 CUMBERLAND HALL PSYCHIATRIC HOSPITAL 7351 STANDIFER GAP RD CHATTANOOGA TN 37421 (423) 499-9007 320 444017 PENINSULA HOSPITAL 2347 JONES BEND RD LOUISVILLE TN 37777 (865) 970-9800 40 450002 PROVIDENCE MEMORIAL HOSPITAL 2001 N OREGON ST EL PASO TX 79902 (915) 542-6011 480 450005 MEMORIAL HERMAN BAPTIST HOSP ORANGE 608 STRICKLAND DRIVE ORANGE TX 77630 (409) 883-9361 840 450007 SID PETERSON MEMORIAL HOSPITAL 710 WATER ST KERRVILLE TX 78028 (210) 896-4200 734 450008 KINGS DAUGHTERS HOSPITAL 1901 SW H K DODGEN LOOP TEMPLE TX 76502 (817) 771-8600 120 450010 UNITED REGIONAL HEALTH CARE SYSTEM 1600 8TH AVENUE WICHITA FALLS TX 76301 (940) 764-7000 960 450011 ST JOSEPH REGIONAL HEALTH CENTER 2801 FRANCISCAN DR BRYAN TX 77802 (979) 776-3777 190 450014 MEMORIAL MEDICAL CENTER 815 N VIRGINIA STREET PORT LAVACA TX 77979 (512) 552-6713 224 450015 PARKLAND HEALTH AND HOSPITAL SYSTEM 5201 HARRY HINES BLVD DALLAS TX 75235 (214) 590-8076 390 450018 UNIVERSITY OF TEXAS MEDICAL BRANCH GAL 301 UNIVERSITY BOULEVARD GALVESTON TX 77555 (409) 772-1220 550 450020 JOHNS COMMUNITY HOSPITAL 305 MALLARD LN TAYLOR TX 76574 (512) 352-7611 970 450021 BAYLOR UNIVERSITY MEDICAL CENTER 3500 GASTON AVE DALLAS TX 75246 (214) 820-0111 390 450023 CITIZENS MEDICAL CENTER 2701 HOSPITAL DRIVE VICTORIA TX 77901 (512) 573-9181 948 450024 R E THOMASON GENERAL HOSPITAL 4815 ALAMEDA AVE EL PASO TX 79905 (915) 544-1200 480 450028 BROWNSVILLE MEDICAL CENTER 1040 W JEFFERSON ST BROWNSVILLE TX 78520 (210) 544-1400 240 450029 MERCY HEALTH CENTER 1700 EAST SAUNDERS LAREDO TX 78044 (956) 796-5000 953 450031 MEDICAL CENTER OF MESQUITE,THE 1011 N GALLOWAY BOX 1008 MESQUITE TX 75149 (214) 320-7000 390 450032 MARSHALL REGIONAL MEDICAL CENTER 811 S WASHINGTON BOX 1599 MARSHALL TX 75670 (903) 927-6000 620 450033 VALLEY BAPTIST MEDICAL CENTER 2101 PEASE ST BOX 2588 HARLINGEN TX 78550 (956) 389-1100 240 450034 CHRISTUS ST ELIZABETH HOSPITAL 2830 CALDER AVENUE BEAUMONT TX 77702 (409) 892-7171 700 450035 CHRISTUS ST JOSEPH HOSPITAL 1919 LABRANCH HOUSTON TX 77002 (713) 757-1000 610 450037 GOOD SHEPHERD MEDICAL CENTER 700 EAST MARSHALL AVENUE LONGVIEW TX 75601 (903) 236-2000 570 450039 JPS HEALTH NETWORK 1500 S MAIN ST FORT WORTH TX 76104 (817) 921-3431 910 450040 COVENANT MEDICAL CENTER 3615 19TH STREET LUBBOCK TX 79410 (806) 796-6000 770 450042 PROVIDENCE HEALTH CENTER 6901 MEDICAL PARKWAY PO BOX 2589 78702WACO TX 76712 (254) 751-4000 780 450044 ST PAUL UNIVERSITY HOSPITAL 5909 HARRY HINES BLVD DALLAS TX 75235 (214) 879-1000 390 450046 CHRISTUS SPOHN HOSPITAL MEMORIAL 2606 HOSPITAL BLVD CORPUS CHRISTI TX 78405 (512) 902-4103 830 450047 DOLLY VINSANT MEMORIAL HOSPITAL 400 E HWY 77 PO BOX 42 SAN BENITO TX 78586 (512) 399-1313 240 450050 WARD MEMORIAL HOSPITAL 406 S GARY ST MONAHANS TX 79756 (915) 943-2511 951 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 124 Provider ID Hospital Name Address City State ZIP Telephone County 450051 METHODIST MEDICAL CENTER 1441 N BECKLEY AVE DALLAS TX 75203 (214) 947-2500 390 450052 GOODALL WITCHER HEALTHCARE FOUNDATION 101 S AVE T CLIFTON TX 76634 (254) 675-8322 160 450053 LAVACA MEDICAL CENTER 1400 NORTH TEXANA STREET HALLETTSVILLE TX 77964 (361) 798-3671 754 450054 SCOTT & WHITE MEMORIAL HOSPITAL 2401 31ST ST TEMPLE TX 76508 (817) 774-2111 120 450055 ROLLING PLAINS MEMORIAL HOSPITAL 200 E ARIZONA SWEETWATER TX 79556 (915) 235-1701 822 450056 SETON MEDICAL CENTER 1201 W 38TH ST AUSTIN TX 78705 (512) 323-1000 940 450058 BAPTIST HEALTH SYSTEM 111 DALLAS STREET SAN ANTONIO TX 78205 (210) 222-8431 130 450059 MCKENNA MEMORIAL HOSPITAL 600 N UNION AVE NEW BRAUNFELS TX 78130 (512) 625-9111 320 450064 ARLINGTON MEMORIAL HOSPITAL 800 W RANDOL MILL RD ARLINGTON TX 76012 (817) 548-6100 910 450068 HERMANN HOSPITAL 6411 FANNIN HOUSTON TX 77030 (713) 797-3443 610 450072 BRAZOSPORT MEMORIAL HOSPITAL 100 MEDICAL DR LAKE JACKSON TX 77566 (409) 297-4411 180 450073 D M COGDELL MEMORIAL HOSPITAL 1700 COGDELL BLVD SNYDER TX 79549 (915) 573-6374 888 450076 UNIV OF TX M D ANDERSON CANCER CTR,THE 1515 HOLCOMBE BLVD HOUSTON TX 77030 (713) 792-2121 610 450078 ANSON GENERAL HOSPITAL 101 AVENUE J ANSON TX 79501 (915) 823-3231 721 450079 BAYLOR MEDICAL CENTER AT IRVING 1901 N MACARTHUR BLVD IRVING TX 75061 (972) 579-8100 390 450080 TITUS COUNTY MEMORIAL HOSPITAL 2001 N JEFFERSON MOUNT PLEASANT TX 75455 (903) 577-6000 531 450081 YOAKUM COMMUNITY HOSPITAL 1200 CARL RAMERT DRIVE YOAKUM TX 77995 (361) 293-2321 754 450082 CHRISTUS SPOHN HOSPITAL BEEVILLE 1500 E HOUSTON HWY BEEVILLE TX 78102 (512) 354-2125 113 450083 EAST TEXAS MEDICAL CENTER 1000 S BECKHAM BOX 6400 TYLER TX 75701 (903) 597-0351 892 450085 GRAHAM REGIONAL MEDICAL CENTER 1301 MONTGOMERY RD,P O BOX 1390 GRAHAM TX 76450 (940) 549-3400 981 450087 NORTH HILLS HOSPITAL 4401 BOOTH CALLOWAY ROAD NORTH RICHLAND HILL TX 76180 (817) 255-1000 910 450090 GAINESVILLE MEMORIAL HOSPITAL 1016 RITCHEY ST GAINESVILLE TX 76240 (940) 665-1751 340 450092 FORT DUNCAN MEDICAL CENTER 350 S ADAMS ST EAGLE PASS TX 78852 (512) 773-5321 791 450094 DALLAS SOUTHWEST MEDICAL CENTER 2929 S HAMPTON RD DALLAS TX 75224 (214) 330-4611 390 450096 CHRISTUS ST MARY HOSPITAL 3600 GATES BLVD PORT ARTHUR TX 77642 (409) 985-7431 700 450097 BAYSHORE MEDICAL CENTER 4000 SPENCER HWY PASADENA TX 77504 (713) 944-6666 610 450098 EAST TEXAS MEDICAL CENTER PITTSBURG 414 QUITMAN STREET PITTSBURG TX 75686 (903) 856-6663 250 450099 PAMPA REGIONAL MEDICAL CENTER 1 MEDICAL PLAZA PAMPA TX 79065 (806) 665-3721 563 450101 HILLCREST BAPTIST MEDICAL CENTER 3000 HERRING WACO TX 76708 (254) 756-8011 780 450102 MOTHER FRANCES HOSPITAL 800 EAST DAWSON TYLER TX 75701 (903) 593-8441 892 450104 GUADALUPE VALLEY HOSPITAL 1215 E COURT ST SEGUIN TX 78155 (512) 379-2411 581 450107 LAS PALMAS MEDICAL CENTER 1801 NORTH OREGON STREET EL PASO TX 79902 (915) 521-1200 480 450108 WILSON MEMORIAL HOSPITAL 1301 HOSPITAL BLVD FLORESVILLE TX 78114 (830) 393-3122 971 450109 MUENSTER MEMORIAL HOSPITAL 605 N MAPLE AVENUE BOX 370 MUENSTER TX 76252 (940) 759-2271 340 450113 PALESTINE REG MED CTR 4000 SOUTH LOOP 256 PALESTINE TX 75801 (903) 731-1000 0 450119 EDINBURG REGIONAL MEDICAL CENTER 1102 W TRENTON ROAD EDINBURG TX 78539 (210) 380-5900 650 450121 OSTEOPATHIC MEDICAL CENTER OF TEXAS 1000 MONTGOMERY ST FORT WORTH TX 76107 (817) 731-4311 910 450123 DOCTORS HOSPITAL 5500 39TH ST GROVES TX 77619 (409) 962-5733 700 450124 BRACKENRIDGE HOSPITAL 601 E 15TH ST AUSTIN TX 78701 (512) 476-6461 940 450126 COLUMBIA E HOUSTON MED CTR E LOOP CAMP 13111 EAST FREEWAY HOUSTON TX 77015 (713) 393-2000 610 450128 KNAPP MEDICAL CENTER 1401 EAST EIGHT STREET PO BOX 1110 WESLACO TX 78596 (210) 968-8567 650 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 125 Provider ID Hospital Name Address City State ZIP Telephone County 450130 NIX MEDICAL CENTER 414 NAVARRO SAN ANTONIO TX 78205 (512) 271-2197 130 450131 NORTHWEST REGIONAL HOSPITAL 13725 FARM RD 624, PO BOX 9917 CORPUS CHRISTI TX 78469 (512) 387-1541 830 450132 MEDICAL CENTER HOSPITAL 500 W 4TH ST DRAWER 7239 ODESSA TX 79760 (915) 640-4000 451 450133 MIDLAND MEMORIAL HOSPITAL 2200 WEST ILLINOIS AVE MIDLAND TX 79701 (915) 685-1111 794 450135 HARRIS METHODIST FORT WORTH 1301 PENNSYLVANIA FORT WORTH TX 76104 (817) 882-2000 910 450137 BAYLOR ALL SAINTS MEDICAL CENTER AT FW 1400 EIGHTH AVE FORT WORTH TX 76104 (817) 926-2544 910 450140 CRANE MEMORIAL HOSPITAL 1310 S ALFORD ST CRANE TX 79731 (915) 558-3555 360 450143 SMITHVILLE REGIONAL HOSPITAL NINTH AND MILLS PO BOX 359 SMITHVILLE TX 78957 (512) 237-3214 100 450144 PERMIAN GENERAL HOSPITAL 720 HOSPITAL DR BOX 2108 ANDREWS TX 79714 (915) 523-2200 10 450146 HANSFORD HOSPITAL 707 S ROLAND SPEARMAN TX 79081 (806) 659-2535 591 450147 DETAR HOSPITAL NAVARRO 506 E SAN ANTONIO ST VICTORIA TX 77902 (512) 575-7441 948 450148 WALLS REGIONAL HOSPITAL 201 WALLS DRIVE CLEBURNE TX 76031 (817) 641-2551 720 450151 FAYETTE MEMORIAL HOSPITAL 543 N JACKSON LA GRANGE TX 78945 (409) 968-3166 511 450152 METROPLEX HOSPITAL 2201 S CLEAR CREEK RD KILLEEN TX 76542 (817) 526-7523 120 450154 VAL VERDE REGIONAL MEDICAL CENTER 801 BEDELL AVE DEL RIO TX 78840 (512) 775-8566 946 450155 HEREFORD REGIONAL MEDICAL CENTER 801 EAST THIRD HEREFORD TX 79045 (806) 364-2141 392 450157 HAMILTON HOSPITAL 901 W HAMILTON ST BOX 158 OLNEY TX 76374 (940) 564-5521 981 450160 MEMORIAL HOSPITAL 209 N W 8TH ST SEMINOLE TX 79360 (915) 758-5811 542 450162 HIGHLAND MEDICAL CENTER 2412 50TH ST LUBBOCK TX 79412 (806) 795-8251 770 450163 CHRISTUS SPOHN HOSPITAL KLEBERG 1311 EAST GENERAL CAVAZOS BLVD KINGSVILLE TX 78363 (512) 595-1661 743 450165 SOUTH TEXAS REGIONAL MEDICAL CENTER 1905 HWY 97 EAST JOURDANTON TX 78026 (512) 769-3515 60 450176 MISSION HOSPITAL INC 900 SOUTH BRYAN ROAD MISSION TX 78572 (210) 580-9000 650 450177 UVALDE MEMORIAL HOSPITAL 1025 GARNER FIELD ROAD UVALDE TX 78801 (512) 278-6251 945 450178 PECOS COUNTY MEMORIAL HOSPITAL 387 WEST I 10 FORT STOCKTON TX 79735 (915) 336-2241 845 450184 MEMORIAL HOSPITAL SYSTEM 7737 SOUTHWEST FREEWAY SUITE 200 HOUSTON TX 77074 (713) 776-6992 610 450185 COLLINGSWORTH GENERAL HOSPITAL 1014 15TH STREET WELLINGTON TX 79095 (806) 447-2521 311 450187 TRINITY COMMUNITY MED CENTER OF BREHAM 700 MEDICAL PARKWAY BRENHAM TX 77833 (979) 836-6173 952 450188 EAST TEXAS MED CENTER - CLARKSVILLE P O DRAWER 1270 HIGHWAY 82 WEST CLARKSVILLE TX 75426 (903) 427-3851 874 450191 GEORGETOWN HOSPITAL 2000 SCENIC DR GEORGETOWN TX 78626 (512) 863-6531 970 450192 HILL REGIONAL HOSPITAL 101 CIRCLE DR HILLSBORO TX 76645 (254) 582-8425 651 450193 ST LUKES EPISCOPAL HOSPITAL 6720 BERTNER HOUSTON TX 77030 (713) 791-3862 610 450194 EAST TEXAS MEDICAL CENTER JACKSONVILLE 501 S RAGSDALE JACKSONVILLE TX 75766 (903) 586-3000 281 450196 CHRISTUS ST JOSEPHS HEALTH SYSTEM 820 CLARKSVILLE ST PARIS TX 75460 (903) 785-4521 750 450200 WADLEY REGIONAL MEDICAL CENTER 1000 PINE STREET TEXARKANA TX 75501 (903) 798-8000 170 450201 REEVES COUNTY HOSPITAL 2323 TEXAS ST BOX 2058 PECOS TX 79772 (915) 447-3551 875 450203 CAMPBELL HEALTH SYSTEM 713 E ANDERSON ST WEATHERFORD TX 76086 (817) 596-8751 843 450209 NORTHWEST TEXAS HOSPITAL 1501 COULTER RD P O BOX 1110 AMARILLO TX 79106 (806) 354-1000 860 450210 EAST TEXAS MEDICAL CENTER-CARTHAGE 409 WEST COTTAGE CARTHAGE TX 75633 (93) 693-3841 842 450211 MEMORIAL MED CENTER OF EAST TEXAS 1201 WEST FRANK STREET LUFKIN TX 75901 (936) 634-8111 20 450213 UNIVERSITY HEALTH SYSTEM 4502 MEDICAL DR SAN ANTONIO TX 78229 (210) 358-4000 130 450214 GULF COAST MEDICAL CENTER 1400 U S 59 N BYPASS WHARTON TX 77488 (409) 532-2500 954 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 126 Provider ID Hospital Name Address City State ZIP Telephone County 450219 LLANO MEMORIAL HEALTHCARE SYSTEM 200 W OLLIE LLANO TX 78643 (915) 247-5040 761 450221 MEMORIAL HOSPITAL 224 E SECOND STREET DUMAS TX 79029 (806) 935-7171 802 450222 CONROE REGIONAL MEDICAL CENTER 504 MEDICAL CENTER BLVD CONROE TX 77304 (409) 539-1111 801 450224 PRESBYTERIAN HOSPITAL OF WINNSBORO 719 WEST COKE ROAD BOX 106 WINNSBORO TX 75494 (903) 342-5227 974 450229 HENDRICK MEDICAL CENTER 1242 NORTH 19TH STREET ABILENE TX 79601 (915) 670-2000 911 450231 BAPTIST ST ANTHONYS HS BAPTIST CAMPUS 1600 WALLACE BLVD AMARILLO TX 79106 (806) 376-4411 860 450234 COMANCHE COMMUNITY HOSPITAL 211 SOUTH AUSTIN PO BOX 443 COMANCHE TX 76442 (915) 356-5241 321 450235 MEMORIAL HOSPITAL HIGHWAY 90A BYPASS BOX 587 GONZALES TX 78629 (210) 672-7581 562 450236 HOPKINS COUNTY MEMORIAL HOSPITAL 115 AIRPORT RD SULPHUR SPRINGS TX 75482 (903) 885-7671 654 450237 CHRISTUS SANTA ROSA HOSPITAL 519 W HOUSTON ST SAN ANTONIO TX 78207 (512) 228-2011 130 450239 CORYELL MEMORIAL HOSPITAL 1507 W MAIN STREET GATESVILLE TX 76528 (817) 865-8251 341 450241 FAITH COMMUNITY HOSPITAL 717 MAGNOLIA ST JACKSBORO TX 76458 (940) 567-6633 680 450243 HAMLIN MEMORIAL HOSPITAL 632 N W SECOND ST BOX 387 HAMLIN TX 79520 (915) 576-3646 721 450249 HARDEMAN COUNTY MEMORIAL HOSPITAL 402 MERCER ST QUANAH TX 79252 (817) 663-2795 592 450250 THROCKMORTON COUNTY MEM HOSPITAL 1100 N MINTER AVE BOX 729 THROCKMORTON TX 76483 (817) 849-2151 920 450253 BELLVILLE GENERAL HOSPITAL 44 N CUMMINGS PO BOX 148 BELLVILLE TX 77418 (409) 865-3141 70 450258 PARKVIEW HOSPITAL 901 SWEETWATER PO BOX 1030 WHEELER TX 79096 (806) 826-5581 955 450264 SWISHER MEMORIAL HOSPITAL 539 SOUTHEAST SECOND STREET TULIA TX 79088 (806) 995-3581 905 450269 PLAINS MEMORIAL HOSPITAL 310 W HALSELL ST BOX 278 DIMMITT TX 79027 (806) 647-2191 270 450270 LAKE WHITNEY MEDICAL CENTER 200 N SAN JACINTO ST BOX 458 WHITNEY TX 76692 (254) 694-3165 651 450271 WISE REGIONAL HEALTH SYSTEM 2000 S FM 51 DECATUR TX 76234 (940) 627-5921 973 450272 CENTRAL TEXAS MEDICAL CENTER 1301 WONDER WORLD DRIVE SAN MARCOS TX 78667 (512) 353-8979 631 450276 CLAY COUNTY MEMORIAL HOSPITAL 310 W SOUTH STREET HENRIETTA TX 76365 (940) 538-5621 291 450280 BAYLOR MEDICAL CENTER AT GARLAND 2300 MARIE CURIE GARLAND TX 75042 (972) 487-5371 390 450283 COZBY GERMANY HOSPIAL 707 N WALDRIP GRAND SALINE TX 75140 (903) 962-4242 947 450288 DELEON HOSPITAL 407 S TEXAS ST BOX 319 DE LEON TX 76444 (254) 893-2011 321 450289 HARRIS COUNTY HOSPITAL DISTRICT 1504 TAUB LOOP HOUSTON TX 77030 (713) 746-5400 610 450292 PRESBYTERIAN HOSPITAL OF KAUFMAN HWY 243 W AT HWY 175 PO BOX 310 KAUFMAN TX 75142 (972) 932-7382 730 450293 FRIO REGIONAL HOSPITAL 200 S IH 35 PEARSALL TX 78061 (830) 334-3617 541 450296 CLEVELAND REGIONAL MEDICAL CTR 300 E CROCKETT CLEVELAND TX 77327 (281) 593-1811 757 450299 COLLEGE STATION MEDICAL CENTER 1604 ROCK PRAIRIE ROAD COLLEGE STATION TX 77840 (979) 764-5100 190 450303 CROSBYTON CLINIC HOSPITAL 710 WEST MAIN STREET CROSBYTON TX 79322 (806) 675-2382 362 450306 STAMFORD MEMORIAL HOSPITAL 1601 COLUMBIA STREET PO BOX 911 STAMFORD TX 79553 (915) 773-3781 721 450309 MEDINA COMMUNITY HOSPITAL 3100 AVENUE E HONDO TX 78861 (512) 426-5363 792 450315 LELAND MEDICAL PLAZA 2696 WEST WALNUT STREET GARLAND TX 75042 (972) 276-7116 390 450324 TEXOMA MEDICAL CENTER 1000 MEMORIAL DR BOX 890 DENISON TX 75020 (903) 465-2313 564 450327 SHAMROCK GENERAL HOSPITAL 1000 S MAIN ST SHAMROCK TX 79079 (806) 256-2423 955 450330 POLLY RYON HOSP AUTHORITY 1705 JACKSON ST RICHMOND TX 77469 (713) 342-2811 530 450340 SAN ANGELO COMMUNITY MEDICAL CENTER 3501 KNICKERBOCKER RD SAN ANGELO TX 76904 (915) 949-9511 930 450346 MEMORIAL HERMANN BAPTIST HOSPITAL 3576 COLLEGE STREET AT 11TH STREET BEAUMONT TX 77701 (409) 835-3781 700 450347 HUNTSVILLE MEMORIAL HOSPITAL 110 MEMORIAL HOSPITAL DRIVE HUNTSVILLE TX 77340 (936) 291-3411 949 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 127 Provider ID Hospital Name Address City State ZIP Telephone County 450348 FALLS COMMUNITY HOSP AND CLINIC 322 COLEMAN ST BOX 60 MARLIN TX 76661 (254) 803-3561 500 450351 HARRIS METHODIST ERATH COUNTY 411 N BELKNAP ST STEPHENVILLE TX 76401 (254) 965-1513 490 450352 PRESBYTERIAN HOSPITAL OF GREENVILLE 4215 JOE RAMSEY BLVD GREENVILLE TX 75401 (903) 408-5000 670 450353 ALICE REGIONAL HOSPITAL 2500 EAST MAIN ALICE TX 78332 (512) 664-4376 711 450358 METHODIST HOSPITAL,THE 6565 FANNIN HOUSTON TX 77030 (713) 790-2940 610 450362 SETON HIGHLAND LAKES 3201 SOUTH WATER ST PO BOX 1219 BURNET TX 78611 (512) 715-3076 222 450369 CHILDRESS REGIONAL MEDICAL CENTER HWY 83 NORTH BOX 1030 CHILDRESS TX 79201 (940) 937-6371 290 450370 COLUMBUS COMMUNITY HOSPITAL 110 SHULT DR PO BOX 865 COLUMBUS TX 78934 (409) 732-2371 312 450372 BAYLOR MEDICAL CENTER AT WAXAHACHIE 1405 W JEFFERSON ST WAXAHACHIE TX 75165 (972) 923-7000 470 450373 EAST TEXAS MEDICAL CENTER MOUNT VERNON HWY 37 SOUTH BOX 477 MOUNT VERNON TX 75457 (903) 537-4552 531 450374 COCHRAN MEMORIAL HOSPITAL 201 EAST GRANT MORTON TX 79346 (806) 266-5565 292 450378 BAYOU CITY MEDICAL CENTER 6700 BELLAIRE HOUSTON TX 77074 (713) 774-7611 610 450379 RHD MEMORIAL MEDICAL CENTER 7 MEDICAL PARKWAY DALLAS TX 75234 (972) 247-1000 390 450381 SETON EDGAR B DAVIS 130 HAYS STREET LULING TX 78648 (830) 875-7000 223 450388 SWT METH HOSP METH CHILDRENS HOSP S TX 7700 FLOYD CURL DR SAN ANTONIO TX 78229 (512) 692-4000 130 450389 EAST TEXAS MEDICAL CENTER ATHENS 2000 SOUTH PALESTINE ATHENS TX 75751 (903) 675-2216 640 450393 WILSON N JONES MEMORIAL HOSP-NORTH CAM 1111 GALLAGHER ROAD SHERMAN TX 75090 (903) 870-7000 564 450395 MEMORIAL MEDICAL CENTER LIVINGSTON 602 E CHURCH ST LIVINGSTON TX 77351 (936) 327-4381 850 450399 BROWNFIELD REGIONAL MEDICAL CENTER 703 E FELT ST BROWNFIELD TX 79316 (806) 637-3551 913 450400 PARKVIEW REGIONAL HOSPITAL 600 SOUTH BONHAM STREET MEXIA TX 76667 (254) 562-5332 758 450403 NORTH CENTRAL MEDICAL CENTER 4500 MEDICAL CENTER DRIVE MCKINNEY TX 75069 (972) 569-8000 310 450411 EASTLAND MEMORIAL HOSPITAL 304 S DAUGHERTY BOX 897 EASTLAND TX 76448 (254) 629-2601 450 450417 LIBERTY DAYTON HOSPITAL INC 1353 NORTH TRAVIS STREET LIBERTY TX 77575 (936) 336-7316 757 450418 BELLAIRE MEDICAL CENTER 5314 DASHWOOD HOUSTON TX 77081 (713) 512-1400 610 450419 HARRIS METHODIST NORTHWEST 108 DENVER TRAIL AZLE TX 76020 (817) 444-8600 843 450422 MARY SHIELS HOSPITAL 3515 HOWELL STREET DALLAS TX 75204 (214) 443-3000 390 450424 SAN JACINTO METHODIST HOSPITAL 4401 GARTH ROAD BAYTOWN TX 77521 (713) 420-8600 610 450431 ST DAVIDS HOSPITAL 919 E 32ND ST AUSTIN TX 78705 (512) 397-4262 940 450438 COLORADO FAYETTE MEDICAL CENTER 400 YOUENS DRIVE WEIMAR TX 78962 (409) 725-9531 312 450446 RIVERSIDE GENERAL HOSPITAL 3204 ENNIS ST HOUSTON TX 77004 (713) 526-2441 610 450447 NAVARRO REGIONAL HOSPITAL 3201 WEST HIGHWAY 22 CORSICANA TX 75110 (903) 654-6800 820 450451 GLEN ROSE MEDICAL CENTER 1021 HOLDEN STREET BOX 2159 GLEN ROSE TX 76043 (254) 897-2215 893 450460 TYLER COUNTY HOSPITAL 1100 WEST BLUFF WOODVILLE TX 75979 (409) 283-8141 942 450462 PRESBYTERIAN HOSPITAL OF DALLAS 8200 WALNUT HILL LANE DALLAS TX 75231 (214) 345-4111 390 450464 HASKELL MEMORIAL HOSPITAL 1 NORTH AVE N P O BOX 1117 HASKELL TX 79521 (940) 864-2621 630 450465 MATAGORDA GENERAL HOSPITAL 1115 AVE G BAY CITY TX 77414 (409) 245-6383 790 450469 WILSON N JONES MEDICAL CENTER 500 N HIGHLAND SHERMAN TX 75091 (903) 870-4611 564 450475 HENDERSON MEMORIAL HOSPITAL 300 WILSON STREET HENDERSON TX 75652 (903) 657-7541 881 450484 WOODLAND HEIGHTS MEDICAL CENTER 505 SOUTH JOHN REDDITT DRIVE LUFKIN TX 75904 (936) 634-8311 20 450488 ROY H LAIRD MEMORIAL HOSPITAL 1612 SOUTH HENDERSON BLVD KILGORE TX 75662 (903) 984-3505 570 450489 MEDICAL ARTS HOSPITAL 1600 N BRYAN AVE LAMESA TX 79331 (806) 872-2183 391 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 128 Provider ID Hospital Name Address City State ZIP Telephone County 450497 BOWIE MEMORIAL HOSPITAL 705 EAST GREENWOOD AV BOWIE TX 76230 (940) 872-1126 800 450498 STEPHENS MEMORIAL HOSPITAL 200 SOUTH GENEVA BRECKENRIDGE TX 76024 (254) 559-2241 901 450508 MEMORIAL HOSPITAL 1204 MOUND ST NACOGDOCHES TX 75961 (936) 564-4611 810 450514 MID-JEFFERSON HOSPITAL HWY 365 AND 27TH ST NEDERLAND TX 77627 (409) 727-2321 700 450517 MEMORIAL MEDICAL CENTER SAN AUGUSTINE 511 HOSPITAL ST BOX 658 SAN AUGUSTINE TX 75972 (936) 275-3446 883 450518 PARK PLACE MEDICAL CENTER 3050 39TH STREET PORT ARTHUR TX 77642 (409) 983-4951 700 450530 MAINLAND MEDICAL CENTER 6801 EMMETT LOWRY EXPRESSWAY TEXAS CITY TX 77591 (409) 948-8411 550 450534 OCHILTREE GENERAL HOSPITAL 3101 GARRETT DRIVE PERRYTON TX 79070 (806) 435-3606 831 450535 BAYCOAST MEDICAL CENTER 1700 JAMES BOWIE DRIVE BOX 1451 BAYTOWN TX 77520 (713) 420-6400 610 450537 BAYLOR/RICHARDSON MEDICAL CENTER 401 W CAMPBELL RD RICHARDSON TX 75080 (972) 498-4797 390 450539 COVENANT HOSPITAL PLAINVIEW 2601 DIMMITT RD PLAINVIEW TX 79072 (806) 296-5531 582 450547 EAST TEXAS MEDICAL CENTER QUITMAN 117 WINNSBORO STREET QUITMAN TX 75783 (903) 763-4505 974 450558 ABILENE REGIONAL MEDICAL CENTER 6250 HWY 83-84 AT ANTILLEY ROAD ABILENE TX 79606 (915) 695-9900 911 450563 BAYLOR MEDICAL CENTER AT GRAPEVINE 1650 W COLLEGE ST GRAPEVINE TX 76051 (817) 481-1588 910 450565 PALO PINTO GENERAL HOSPITAL 400 SOUTHWEST 25 AVE MINERAL WELLS TX 76067 (940) 328-6400 841 450571 SHANNON WEST TEXAS MEMORIAL HOSPITAL 120 EAST HARRIS STREET SAN ANGELO TX 76903 (915) 653-6741 930 450573 CHRISTUS JASPER MEMORIAL HOSPITAL 1275 MARVIN HANCOCK DRIVE JASPER TX 75951 (409) 384-5461 690 450578 HEMPHILL COUNTY HOSPITAL 1020 S 4TH ST CANADIAN TX 79014 (806) 323-6422 632 450580 EAST TEXAS MEDICAL CENTER CROCKETT 1100 LOOP 304 EAST BOX 1129 CROCKETT TX 75835 (936) 546-3862 660 450584 WILBARGER GENERAL HOSPITAL 920 HILLCREST DR VERNON TX 76384 (940) 552-9351 961 450586 SEYMOUR HOSPITAL 200 STADIUM DRIVE BOX 351 SEYMOUR TX 76380 (817) 888-5572 110 450587 BROWNWOOD REGIONAL MEDICAL CENTER 1501 BURNET DR BROWNWOOD TX 76801 (915) 646-8541 220 450591 ANGLETON-DANBURY MEDICAL CENTER 132 HOSPITAL DR ANGLETON TX 77515 (409) 849-7721 180 450596 LAKE GRANBURY MEDICAL CENTER 1310 PALUXY RD GRANBURY TX 76048 (817) 573-2683 653 450597 CUERO COMMUNITY HOSPITAL 2550 N ESPLANADE CUERO TX 77954 (512) 275-6191 420 450603 CULBERSON COUNTY HOSPITAL DISTRICT EISENHOWER RD AND FM 2185 BOX 609 VAN HORN TX 79855 (915) 283-2760 370 450604 HILL COUNTRY MEMORIAL HOSPITAL INC 1020 KERRVILLE HIGHWAY PO BOX 835 FREDERICKSBURG TX 78624 (830) 997-4353 552 450605 NORTH BAY HOSPITAL 1711 W WHEELER AVENUE ARANSAS PASS TX 78336 (512) 758-8585 885 450609 LYNN COUNTY HOSPITAL DISTRICT 2600 LOCKWOOD BOX 1310 TAHOKA TX 79373 (806) 998-4533 771 450610 MEMORIAL HOSPITAL MEMORIAL CITY 920 FROSTWOOD DR HOUSTON TX 77024 (713) 932-3592 610 450615 ATLANTA MEMORIAL HOSPITAL 1007 SOUTH WILLIAMS STREET ATLANTA TX 75551 (903) 796-4151 260 450617 CLEAR LAKE REG MEDICAL CENTER 500 MEDICAL CENTER BLVD WEBSTER TX 77598 (713) 332-2511 610 450620 DIMMIT COUNTY MEMORIAL HOSPITAL 704 HOSPITAL DRIVE CARRIZO SPRINGS TX 78834 (512) 876-2424 430 450623 NORTHEAST MEDICAL CENTER 504 LIPSCOMB BLVD BONHAM TX 75418 (903) 640-7366 510 450626 JACKSON COUNTY HOSPITAL 1013 S WELLS EDNA TX 77957 (512) 782-5241 681 450630 COLUMBIA SPRING BRANCH MEDICAL CENTER 8850 LONG POINT ROAD PO BOX 55227 HOUSTON TX 77055 (713) 467-6555 610 450632 W J MANGOLD MEMORIAL HOSPITAL 320 N MAIN ST BOX 37 LOCKNEY TX 79241 (806) 652-3373 521 450634 DENTON REGIONAL MEDICAL CENTER 3535 SOUTH I35 EAST DENTON TX 76205 (940) 384-3535 410 450638 HOUSTON NORTHWEST MEDICAL CENTER 710 FM 1960 WEST HOUSTON TX 77090 (713) 440-1000 610 450639 HARRIS METHODIST H E B 1600 HOSPITAL PARKWAY BEDFORD TX 76022 (817) 685-4600 910 450641 NOCONA GENERAL HOSPITAL 100 PARK ROAD NOCONA TX 76255 (940) 825-3235 800 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 129 Provider ID Hospital Name Address City State ZIP Telephone County 450643 DOCTORS HOSPITAL OF LAREDO 10700 MCPHERSON ROAD LAREDO TX 78041 (512) 723-1131 953 450644 WEST HOUSTON MEDICAL CENTER 12141 RICHMOND AVE HOUSTON TX 77082 (281) 558-3444 610 450646 DEL SOL MEDICAL CENTER 10301 GATEWAY WEST EL PASO TX 79925 (915) 595-9000 480 450647 MEDICAL CITY DALLAS HOSPITAL -- 7777 FOREST LANE DALLAS TX 75230 (972) 566-6000 390 450648 RICHARDS MEMORIAL HOSPITAL 1700 BRAZOS ST ROCKDALE TX 76567 (512) 446-2513 795 450649 HEART OF TEXAS MEMORIAL HOSPITAL NINE ROAD PO BOX 1150 BRADY TX 76825 (915) 597-2901 772 450651 MEDICAL CENTER OF PLANO 3901 W 15TH ST PLANO TX 75075 (214) 596-6800 310 450653 SCENIC MOUNTAIN MEDICAL CENTER 1601 W 11TH PLACE BIG SPRING TX 79720 (915) 263-1211 661 450654 STARR COUNTY MEMORIAL HOSPITAL FM RD 3167 BOX 78 RIO GRANDE CITY TX 78582 (512) 487-5561 900 450656 NACOGDOCHES MEDICAL CENTER 4920 NE STALLINGS DRIVE NACOGDOCHES TX 75961 (936) 569-9481 810 450658 EAST TEXAS MEDICAL CENTER - FAIRFIELD 125 NEWMAN ST FAIRFIELD TX 75840 (903) 389-2121 540 450659 PARK PLAZA HOSPITAL 1313 HERMANN DR HOUSTON TX 77004 (713) 527-5000 610 450661 ODESSA REGIONAL HOSPITAL 520 E 6TH ST BOX 4859 79760 ODESSA TX 79761 (915) 334-8200 451 450662 VALLEY REGIONAL MEDICAL CENTER 100 A ALTON GLOOR BROWNSVILLE TX 78521 (956) 350-7000 240 450665 OTTO KAISER MEMORIAL HOSPITAL 3349 S HIGHWAY 181 KENEDY TX 78119 (512) 583-3401 722 450668 SIERRA MEDICAL CENTER 1625 MEDICAL CENTER DR EL PASO TX 79902 (915) 747-4000 480 450669 MEDICAL CENTER OF LEWISVILLE 500 WEST MAIN STREET LEWISVILLE TX 75057 (972) 420-1000 410 450670 TOMBALL REGIONAL HOSPITAL 605 HOLDERRIETH TOMBALL TX 77375 (281) 351-1623 610 450672 PLAZA MEDICAL CENTER 900 EIGHTH AVENUE FORT WORTH TX 76104 (817) 342-5857 910 450673 ELECTRA MEMORIAL HOSPITAL 1207 S BAILEY ST BOX 1112 ELECTRA TX 76360 (940) 495-3981 960 450674 WOMANS HOSPITAL OF TEXAS,THE 7600 FANNIN HOUSTON TX 77054 (713) 790-1234 610 450675 MEDICAL CENTER OF ARLINGTON 3301 MATLOCK ROAD ARLINGTON TX 76015 (817) 472-4850 910 450677 HUGULEY HEALTH SYSTEM 11801 S FREEWAY PO BOX 6337 FORT WORTH TX 76115 (817) 293-9110 910 450678 DOCTORS HOSPITAL 9440 POPPY DR DALLAS TX 75218 (214) 324-6117 390 450683 MEDICAL CENTER AT TERRELL 1551 HWY 34 S TERRELL TX 75160 (972) 563-7611 730 450684 NORTHEAST MEDICAL CENTER HOSPITAL 18951 MEMORIAL NORTH HUMBLE TX 77338 (713) 540-7700 610 450686 UNIVERSITY MEDICAL CENTER 602 INDIANA AVENUE PO BOX 5980 LUBBOCK TX 79417 (806) 743-3111 770 450688 MESQUITE COMMUNITY HOSPITAL 3500 INTERSTATE 30 AT MOTLEY DRIVE MESQUITE TX 75150 (972) 698-3300 390 450690 UNIVERSITY OF TEXAS HEALTH CENTER 11937 US HIGHWAY 271 TYLER TX 75708 (903) 877-7725 892 450694 EL CAMPO MEMORIAL HOSPITAL 303 SANDY CORNER RD EL CAMPO TX 77437 (409) 543-6251 954 450697 SOUTHWEST GENERAL HOSPITAL 7400 BARLITE BLVD SAN ANTONIO TX 78224 (512) 921-2000 130 450698 LAMB HEALTHCARE CENTER 1500 S SUNSET LITTLEFIELD TX 79339 (806) 385-6411 751 450700 SABINE COUNTY HOSPITAL PO DRAWER W HWY 83 WEST HEMPHILL TX 75948 (409) 787-3300 882 450702 LONGVIEW REGIONAL MEDICAL CENTER 2901 N FOURTH ST LONGVIEW TX 75605 (903) 758-1818 570 450709 CHRISTUS ST JOHN HOSPITAL 18300 ST JOHN DRIVE NASSAU BAY TX 77058 (713) 333-5503 610 450711 RIO GRANDE REGIONAL HOSPITAL 101 E RIDGE RD MC ALLEN TX 78503 (210) 632-6100 650 450713 SOUTH AUSTIN HOSPITAL 901 WEST BEN WHITE BLVD AUSTIN TX 78704 (512) 447-2211 940 450715 MEDICAL CENTER AT LANCASTER 2600 W PLEASANT RUN RD LANCASTER TX 75146 (972) 274-7582 390 450716 CYPRESS FAIRBANKS MED CTR HOSPITAL 10655 STEEPLETOP DRIVE HOUSTON TX 77065 (281) 897-3100 610 450718 ROUND ROCK MEDICAL CENTER 2400 ROUND ROCK AVE ROUND ROCK TX 78681 (512) 255-6066 970 450723 MARGARET JONSSON CHARLTON METH HOSP 3500 W WHEATLAND RD BOX 225357 DALLAS TX 75237 (214) 296-2511 390 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 130 Provider ID Hospital Name Address City State ZIP Telephone County 450727 MITCHELL COUNTY HOSPITAL 1543 CHESTNUT STREET COLORADO CITY TX 79512 (915) 728-3431 797 450730 TRINITY MEDICAL CENTER 4343 NORTH JOSEY LANE CARROLLTON TX 75010 (972) 492-1010 410 450742 LAKE POINTE MEDICAL CENTER 6800 SCENIC DR ROWLETT TX 75088 (972) 412-2273 390 450743 DENTON HOSPITAL 207 N BONNIE BRAE DENTON TX 76201 (940) 898-7000 410 450746 KNOX COUNTY HOSPITAL 701 SOUTH 5TH STREET BOX 608 KNOX CITY TX 79529 (817) 658-3535 744 450747 PALESTINE REGIONAL MEDICAL CENTER 2900 S LOOP 256 PALESTINE TX 75801 (903) 731-1000 0 450749 EAST TEXAS MEDICAL CENTER TRINITY 900 PROSPECT DR TRINITY TX 75862 (936) 594-3541 941 450751 DOCTORS HOSPITAL 520 HOSPITAL DR BOX 7 NEW BOSTON TX 75570 (903) 628-5531 170 450754 HAMILTON GENERAL HOSPITAL 400 N BROWN HAMILTON TX 76531 (254) 386-3151 590 450755 COVENANT HOSPITAL LEVELLAND 1900 COLLEGE AVE LEVELLAND TX 79336 (806) 894-4963 652 450758 HEALTHSOUTH MEDICAL CENTER 2124 RESEARCH ROW DALLAS TX 75235 (214) 904-6100 390 450760 SOUTHWESTERN GEN HOSP 1221 N COTTON EL PASO TX 79902 (915) 533-9361 480 450761 MULESHOE AREA MED CTR 708 S 1ST ST MULESHOE TX 79347 (806) 272-4524 80 450763 GOLDEN PLAINS COMM HOSP 200 S MC GEE BORGER TX 79007 (806) 273-1100 671 450766 ZALE LIPSHY UNIV HOSP 5151 HARRY HINES BLVD DALLAS TX 75235 (214) 590-3000 390 450770 CENTRAL TEXAS HOSP 806 N CROCKETT BOX 947 CAMERON TX 76520 (817) 697-6591 795 450771 PRESBYTERIAN HOSP OF PLANO 6200 W PARKER BLVD PLANO TX 75093 (972) 981-8000 310 450774 TOPS SURGICAL SPECIALTY HOSPITAL 17080 RED OAK DR BOX 73409 HOUSTON TX 77090 (713) 444-0065 610 450775 COLUMBIA KINGWOOD MEDICAL CENTER 22999 US HWY 59 KINGWOOD TX 77325 (713) 359-7500 610 450776 COLEMAN COUNTY MEDICAL CENTER 310 S PECOS ST COLEMAN TX 76834 (915) 625-2135 301 450779 HARRIS METHODIST SOUTHWEST 6100 HARRIS PKWY FORT WORTH TX 76132 (817) 346-5050 910 450780 METHODIST AMBULATORY SURGERY HOSP NW 9150 HUEBNER RD SUITE 100 SAN ANTONIO TX 78240 (512) 561-7250 130 450788 CORPUS CHRISTI MEDICAL CENTER,THE 7101 S PADRE ISLAND DR CORPUS CHRISTI TX 78412 (512) 985-1200 830 450795 HOUSTON COMMUNITY HOSPITAL 2807 LITTLE YORK RD HOUSTON TX 77093 (713) 697-2961 610 450796 NORTHWEST TEXAS SURGERY CENTER 3501 SONCY RD SUITE 118 AMARILLO TX 79109 (806) 359-7999 871 450797 HEALTHSOUTH HOSP FOR SPECIALIZED SURGE 5445 LABRANCH STREET HOUSTON TX 77004 (713) 528-6800 610 450801 CHRISTUS ST MICHAEL HEALTH CARE CENTER 2600 ST MICHAEL DR TEXARKANA TX 75504 (903) 614-1000 170 450803 DOCTORS HOSPITAL TIDWELL 510 W TIDWELL HOUSTON TX 77091 (713) 691-1111 610 450804 TEXAS ORTHOPEDIC HOSPITAL 7401 SOUTH MAIN STREET HOUSTON TX 77030 (713) 799-8600 610 450808 HEALTHSOUTH SURGERY HOSPITAL OF AUSTIN 6818 AUSTIN CTR BLVD SUITE 100 AUSTIN TX 78731 (512) 346-1994 940 450809 NORTH AUSTIN MEDICAL CENTER 12221 MOPAC EXPRESSWAY NORTH AUSTIN TX 78758 (512) 901-1000 940 450811 MC ALLEN HEART HOSP 1900 SO D ST MC ALLEN TX 78503 (210) 994-2000 650 450813 COMMUNITY GENERAL HOSPITAL 230 WEST MILLER DILLEY TX 78017 (210) 965-2003 541 450820 METHODIST SUGAR LAND HOSPITAL 16655 SOUTHWEST FREEWAY SUGAR LAND TX 77479 (281) 274-7000 530 450822 LAS COLINAS MEDICAL CENTER 6800 N MACARTHUR BLVD IRVING TX 75039 (972) 969-2085 390 450824 HEART HOSPITAL OF AUSTIN 3801 N LAMAR BLVD AUSTIN TX 78756 (512) 407-7000 940 450825 CORNERSTONE REGIONAL HOSPITAL 2302 CORNERSTONE BLVD EDINBURG TX 78539 (956) 618-4444 650 450827 KELL WEST REGIONAL HOSPITAL LLC 5402 KELL WEST BLVD WICHITA FALLS TX 76310 (940) 692-5888 960 450828 CHRISTUS SPOHN HOSPITAL ALICE 700 FLOURNOY RD ALICE TX 78332 (512) 661-8000 711 450830 BIG BEND REGIONAL MED CTR HOME HEALTH 2600 HIGHWAY 118 NORTH PO BOX 846339Z7ALPINE TX 79830 (915) 837-3447 200 450831 VISTA MEDICAL CENTER HOSPITAL 4301 B VISTA PASADENA TX 77504 (713) 378-3000 610 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 131 Provider ID Hospital Name Address City State ZIP Telephone County 450832 CHRISTUS ST CATHERINE HEALTH & WELLNES 701 SOUTH FRY ROAD KATY TX 77450 (281) 599-5700 610 450833 ENNIS REGIONAL MEDICAL CENTER 803 WEST LAMPASAS ENNIS TX 75119 (972) 875-0900 470 450834 PHYSICIANS CENTRE,THE 3131 UNIVERSITY DRIVE EAST BRYAN TX 77802 (979) 731-3100 190 450838 DICKERSON MEMORIAL HOSPITAL 1001 DICKERSON DRIVE JASPER TX 75951 (409) 489-0600 690 450839 SHELBY REGIONAL MEDICAL CENTER 602 HURST STREET CENTER TX 75935 (936) 598-2781 890 450840 PRESBYTERIAN HOSPITAL OF ALLEN 1105 CENTRAL EXPRESSWAY NORTH ALLEN TX 75013 (972) 747-1000 910 450841 BROWNSVILLE SURGICAL HOSPITAL 4750 NORTH EXPRESSWAY BROWNSVILLE TX 78521 (956) 554-2019 240 450844 METHODIST WILLOWBROOK HOSPITAL 18220 TOMBALL PARKWAY HOUSTON TX 77070 (281) 477-1361 610 450845 EL PASO SPECIALTY HOSPITAL 1755 CURIE SUTIE A EL PASO TX 79902 (915) 544-3636 480 450846 SCCI HOSPITAL EL PASO 1740 CURIE DRIVE EL PASO TX 79902 (915) 351-9044 480 450847 MEMORIAL HERMANN KATY HOSPITAL 5602 MEDICAL CENTER DRIVE KATY TX 77494 (281) 395-7525 610 450848 MEMORIAL HERMANN FORT BEND HOSPITAL 3803 FM 1092 MISSOURI CITY TX 77459 (281) 499-4800 610 450849 BARIATRIC CARE CENTER OF TEXAS 801 S HWY 78 WYLIE TX 75098 (972) 429-8000 310 450850 HEART PLACE HOSPITAL 25 VILLAGE CIRCLE MIDLAND TX 79701 (915) 683-2255 794 450851 BAYLOR HEART AND VASCULAR CENTER 621 N HALL STREET DALLAS TX 75246 (214) 820-0600 390 450852 SELECT SPECIALTY HOSPITAL SOUTH DALLAS 800 KIRKWOOD DRIVE DESOTO TX 75115 (972) 780-6574 390 451300 PARMER COUNTY COMMUNITY HOSPITAL 1307 CLEVELAND FRIONA TX 79035 (806) 250-2754 844 451301 REAGAN MEMORIAL HOSPITAL 805 NORTH MAIN BIG LAKE TX 76932 (915) 844-2561 872 451302 LINDEN MUNICIPAL HOSPITAL 404 NORTH KAUFMAN STREET LINDEN TX 75563 (903) 756-5561 260 451303 LIMESTONE MEDICAL CENTER 701 MCCLINTIC GROESBECK TX 76642 (254) 729-3281 758 451304 SCHLEICHER COUNTY MEDICAL CENTER 400 WEST MURCHISON ELDORADO TX 76936 (915) 853-2507 887 451305 BURLESON ST JOSEPH HEALTH CENTER 1101 WOODSON DRIVE CALDWELL TX 77836 (979) 567-3245 221 451306 KIMBLE HOSPITAL 2101 MAIN STREET JUNCTION TX 76849 (915) 446-3321 740 451307 PECOS COUNTY GENERAL HOSPITAL 305 WEST 5TH STREET IRAAN TX 79744 (915) 639-2575 845 451308 YOAKUM COUNTY HOSPITAL 412 MUSTANG AVE DENVER CITY TX 79323 (806) 592-2121 980 451309 MC CAMEY HOSPITAL & CONVALESCENT CTR 2500 HWY 305 SOUTH MC CAMEY TX 79752 (915) 652-8626 944 451310 BALLINGER MEMORIAL HOSPITAL 608 AVENUE B BALLINGER TX 76821 (915) 365-2531 880 451311 SWEENY COMMUNITY HOSPITAL 305 NORTH MCKINNEY SWEENY TX 77480 (979) 548-3311 610 451312 RICE MEDICAL CENTER 600 S AUSTIN ROAD EAGLE LAKE TX 77434 (979) 234-5571 610 451313 FISHER COUNTY HOSPITAL DISTRICT 774 STATE HIGHWAY 70 ROTAN TX 79546 (915) 735-2256 520 451314 WINKLER COUNTY MEMORIAL HOSPITAL 821 JEFFEE DRIVE KERMIT TX 79745 (915) 586-5864 972 451315 NORTH RUNNELS HOSPITAL 7821 EAST HIGHWAY 153 WINTERS TX 79567 (915) 754-4553 880 451316 MADISON ST JOSEPH HEALTH CENTER 100 WEST CROSS STREET MADISONVILLE TX 77864 (936) 348-2631 782 451317 REFUGIO COUNTY MEMORIAL HOSPITAL 107 SWIFT STREET REFUGIO TX 78377 (361) 526-2321 876 451318 STONEWALL MEMORIAL HOSPITAL 821 N BROADWAY ASPERMONT TX 79502 (940) 989-3551 903 451319 MOTHER FRANCES HOSPITAL JACKSONVILLE 2026 S JACKSON STREET JACKSONVILLE TX 75766 (903) 541-4500 281 451320 BAYSIDE COMMUNITY HOSPITAL 200 HOSPITAL DRIVE ANAHUAC TX 77514 (409) 267-3143 610 451321 PRESBYTERIAN HOSPITAL OF COMMERCE 2900 STERLING HART DRIVE COMMERCE TX 75428 (903) 886-3161 670 451322 GRIMES ST JOSEPH HEALTH CENTER 210 JUDSON NAVASOTA TX 77868 (936) 825-6585 580 451323 ROLLINS BROOK COMMUNITY 608 NORTH KEY AVENUE LAMPASAS TX 76550 (512) 556-3682 752 451324 LILLIAN M HUDSPETH MEMORIAL HOSPITAL 308 HUDSPETH SONORA TX 76950 (915) 387-2521 904 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 132 Provider ID Hospital Name Address City State ZIP Telephone County 451325 CONCHO COUNTY HOSPITAL 614 EAKER STREET EDEN TX 76837 (915) 869-5911 330 451326 CHILLICOTHE HOSPITAL DISTRICT 303 AVENUE I CHILLICOTHE TX 79225 (940) 852-5131 592 451328 WINNIE COMMUNITY HOSPITAL 538 BROADWAY WINNIE TX 77665 (409) 296-6000 280 451329 RANKIN COUNTY HOSPITAL DISTRICT 1105 ELIZABETH RANKIN TX 79778 (915) 693-2443 944 451330 MEDINA COMMUNITY HOSPITAL 3100 AVENUE E HONDO TX 78861 (830) 741-4677 792 451331 COON MEMORIAL HOSPITAL 1411 DENVER AVENUE DALHART TX 79022 (806) 244-4571 380 451332 PALACIOS COMMUNITY MEDICAL CENTER 311 GREEN AVENUE PALACIOS TX 77465 (361) 972-2511 790 451333 MARTIN COUNTY HOSPITAL DISTRICT 610 NORTH SAINT PETER STREET STANTON TX 79782 (915) 751-3345 784 451334 PARKVIEW HOSPITAL 901 WHEELER TX 79096 (806) 826-5581 955 451990 LEAVES,THE 1230 WEST SPRING VALLEY ROAD BUCKINGHAM TX 75080 (972) 231-4864 390 452013 SOUTH TEXAS HOSPITAL 1301 RANGERVILLE ROAD HARLINGEN TX 78550 (210) 423-3420 240 452015 KINDRED HOSPITAL DALLAS 9525 GREENVILLE AVENUE DALLAS TX 75218 (214) 278-1815 390 452016 KINDRED HOSPITAL SAN ANTONIO 3636 MEDICAL DRIVE SAN ANTONIO TX 78229 (210) 616-0616 130 452017 BAYLOR CENTER FOR RESTORATIVE CARE 3504 SWISS AVE DALLAS TX 75204 (214) 820-9700 390 452018 HARRIS CONTINUED CARE HOSPITAL 1300 PENNSYLVANIA 4TH FLOOR MAIN BLDGFORT WORTH TX 76104 (817) 878-5500 910 452019 KINDRED HOSPITAL FORT WORTH 815 8TH AVENUE FORT WORTH TX 76104 (817) 332-4812 910 452022 SELECT SPECIALTY HOSPITAL-DALLAS #7 MEDICAL PARKWAY 3 WEST DALLAS TX 75234 (972) 488-9167 390 452023 KINDRED HOSPITAL-HOUSTON 6441 MAIN ST HOUSTON TX 77030 (713) 790-0500 610 452027 SCCI HOSPITAL HOUSTON CENTRAL 105 DREW HOUSTON TX 77006 (713) 529-8922 610 452028 KINDRED HOSPITAL-TARRANT COUNTY 1000 N COOPER ST ARLINGTON TX 76011 (817) 543-0200 910 452029 HENDRICK CENTER FOR EXTENDED CARE 1242 N 19TH ST ABILENE TX 79601 (915) 670-5151 911 452031 MEMORIAL SPECIALTY HOSPITAL 1201 FRANK ST SUITE D5 LUFKIN TX 75901 (936) 639-7975 20 452032 SPECIALTY HOSPITAL OF HOUSTON 5556 GASMER HOUSTON TX 77035 (713) 551-5300 610 452033 TEXAS CENTER FOR INFECTIOUS DISEASE 2303 SE MILITARY DR P O BOX 23340 SAN ANTONIO TX 78223 (210) 534-8857 130 452034 SPECIALTY HOSP OF AUSTIN,THE 4207 BURNET RD AUSTIN TX 78756 (512) 706-1900 940 452035 IHS HOSPITAL AT EL PASO 2311 N OREGON STREET EL PASO TX 79902 (915) 548-1823 480 452036 IHS HOSPITAL AT CORPUS CHRISTI 1310 3RD ST CORPUS CHRISTI TX 78404 (512) 888-4323 830 452038 TEXAS NEURO REHABILITATION CENTER 1106 W DITTMAR AUSTIN TX 78745 (512) 444-4835 940 452039 VENCOR HOSPITAL HOUSTON NORTHWEST 11297 FALLBROOK HOUSTON TX 77065 (713) 897-8114 610 452040 IHS HOSPITAL AT SAN ANTONIO 7310 OAK MANOR SAN ANTONIO TX 78229 (210) 308-0261 130 452041 TEXOMA MEDICAL CTR RESTORATIVE CARE 1000 MEMORIAL DR 4TH FLOOR POBOX 890 DENISON TX 75020 (903) 416-4441 564 452042 DUBUIS HOSP OF BEAUMONT 2830 CALDER AVENUE 4TH FLOOR BEAUMONT TX 77702 (409) 899-7680 700 452043 IHS HOSP AT HOUSTON 6160 S LOOP EAST HOUSTON TX 77087 (713) 640-2400 610 452044 LIFECARE HOSPITAL OF DALLAS 6161 HARRY HINES BLVD DALLAS TX 75235 (214) 525-6300 390 452045 COMPASS HOSP OF SAN ANTONIO,THE 14743 JONES MALTSBERGER SAN ANTONIO TX 78247 (210) 402-0029 130 452046 PLAZA SPECIALTY HOSP 1300 BINZ HOUSTON TX 77004 (713) 285-1000 610 452049 SELECT SPECIALTY HOSPITAL-HOUSTON HEIG 1917 ASHLAND HOUSTON TX 77008 (713) 861-6161 610 452050 IHS HOSPITAL AT LUBBOCK 1409 9TH ST LUBBOCK TX 79401 (806) 767-9133 770 452051 EAST TEXAS MED CTR SPECIALTY HOSP 1000 S BECKHAM 5TH FLOOR TYLER TX 75701 (903) 535-6551 892 452053 SUMMIT INSTITUTE OF AUSTIN INC 8402 CROSS PARK DR AUSTIN TX 78754 (512) 837-6233 940 452054 IHS HOSPITAL AT PLANO 1621 COIT ROAD PLANO TX 75075 (972) 758-5200 310 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 133 Provider ID Hospital Name Address City State ZIP Telephone County 452055 DUBUIS HOSPITAL OF HOUSTON 1919 LABRANCH HOUSTON TX 77002 (713) 756-8660 610 452056 SCCI HOSPITAL OF VICTORIA 506 E SAN ANTONIO STREET 3 EAST FLOORVICTORIA TX 77901 (361) 575-1445 948 452057 BEACON HEALTH LTD 9182 SIX PINES DRIVE THE WOODLANDS TX 77380 (713) 364-0317 610 452060 SCCI HOSPITAL OF AMARILLO 2828 SOUTHWEST 27TH AVENUE AMARILLO TX 79109 (806) 351-1600 860 452061 DUBUIS HOSPITAL OF TEXARKANA 2600 ST MICHAEL DRIVE TEXARKANA TX 75503 (903) 614-7600 170 452063 LIFECARE HOSPITALS OF SOUTH TX INC 333 WEST FREDDY GONZALES DRIVE, STE 2 EDINBURG TX 78539 (956) 388-1800 650 452064 SCCI HOSPITAL - SAN ANGELO 2018 PULLIAM SAN ANGELO TX 76905 (915) 659-3906 930 452066 INTEGRATED HEALTH SERVICE HOSPITAL 5601 PLUM CREEK DRIVE AMARILLO TX 79124 (806) 351-1000 860 452067 IHS HOSPITAL AT DALLAS 7850 BROOKHOLLOW RD DALLAS TX 75235 (214) 637-0000 390 452068 IHS HOSPITAL AT WICHITA FALLS 1103 GRACE STREET WICHITA FALLS TX 76301 (940) 720-6633 960 452071 KINDRED HOSPITAL-WHITE ROCK 9440 POPPY DRIVE 5TH FLOOR DALLAS TX 75218 (214) 324-6730 390 452072 MEMORIAL HERMANN CONTINUING CARE HOSPI 3034 N GESSNER HOUSTON TX 77080 (713) 462-2515 610 452073 SELECT SPECIALTY HOSPITAL SAN ANTONIO 111 DALLAS STREET 4TH FLOOR SAN ANTONIO TX 78205 (210) 297-7185 130 452074 TRIUMPH HOSPITAL OF NORTH HOUSTON 233 WEST PARKER ROAD HOUSTON TX 77076 (281) 765-2622 610 452075 TRIUMPH HOSPITAL EAST HOUSTON 15101 EAST FREEWAY CHANNELVIEW TX 77530 (713) 807-8686 610 452077 HEALTHSOUTH REHABILITATION INSTITUTE 17506 RED OAK DRIVE HOUSTON TX 77090 (281) 580-1212 610 453025 INSTUTUTE FOR REHAB & RESEARCH,THE 1333 MOURSUND AVE HOUSTON TX 77030 (713) 799-5000 610 453028 GONZALES WARM SPRINGS REHAB HOSPITAL PO BOX 58 GONZALES TX 78629 (512) 672-6592 562 453029 HEALTHSOUTH REHABILITATION HOSPITAL 19002 MCKAY DRIVE HUMBLE TX 77338 (713) 446-6148 610 453031 HEALTHSOUTH REHAB INST OF SAN ANTONIO 9119 CINNAMON HILL SAN ANTONIO TX 78240 (210) 691-0737 130 453032 NORTH DALLAS REHABILITATION HOSPITAL 8383 MEADOW RD DALLAS TX 75231 (214) 891-0880 390 453033 RIO VISTA REHAB HOSP 1740 CURIE DR EL PASO TX 79902 (915) 544-3399 480 453035 WARM SPRINGS & BAPTIST REHAB NETWORK 5101 MEDICAL DR SAN ANTONIO TX 78229 (210) 616-0100 130 453036 BAYLOR INSTITUTE FOR REHAB AT GASTON 3505 GASTON AVE DALLAS TX 75246 (214) 826-7030 390 453038 ST DAVIDS REHABILITATION CENTER 1005 E 32ND ST AUSTIN TX 78705 (512) 867-5100 940 453040 HEALTHSOUTH REHAB HOSP OF ARLINGTON 3200 MATLOCK ROAD ARLINGTON TX 76015 (817) 468-4000 910 453041 HEALTHSOUTH REHAB CTR 1212 W LANCASTER AVE FORT WORTH TX 76102 (817) 870-2336 910 453042 HEALTHSOUTH CITY VIEW REHAB HOSPITAL 6701 OAKMONT BLVD FORT WORTH TX 76132 (817) 370-4700 910 453044 HEALTHSOUTH REHAB HOSP OF AUSTIN 1215 RED RIVER AUSTIN TX 78701 (512) 474-5700 940 453047 HEALTHSOUTH PLANO REHABILITATION HOSP 2800 W 15TH ST PLANO TX 75075 (972) 612-9000 310 453048 HEALTHSOUTH REHABILITATION HOSPITAL 3340 PLAZA 10 BOULEVARD BEAUMONT TX 77707 (409) 835-0835 700 453052 HEALTHSOUTH CLEAR LAKE REHAB HOSPITAL 655 E MEDICAL CENTER BLVD WEBSTER TX 77598 (713) 286-1500 610 453053 HEALTHSOUTH REHAB HOSP OF TEXARKANA 515 WEST 12TH STREET TEXARKANA TX 75501 (903) 793-0088 170 453054 HEALTHSOUTH REHAB HOSPITAL OF WICHITA 3901 ARMORY ROAD WICHITA FALLS TX 76301 (940) 720-5700 960 453055 CORPUS CHRISTI WARM SPGS REHAB HOSP 2606 HOSPITAL BLVD 8TH FLOOR CORPUS CHRISTI TX 78405 (512) 902-4000 830 453056 HEALTHSOUTH REHAB HOSPITAL OF TYLER 3131 TROUP HWY TYLER TX 75701 (903) 510-7000 892 453057 HEALTHSOUTH REHAB HOSP OF MIDLAND/ODES 1800 HERITAGE BLVD MIDLAND TX 79707 (915) 520-1600 794 453059 HEALTHSOUTH REHAB HOSP NORTH HOUSTON 4000 S WELLMAN CONROE TX 77384 (713) 367-5533 801 453065 CHRISTUS ST MICHAEL REHAB HOSPITAL 2400 ST MICHAEL DRIVE TEXARKANA TX 75503 (903) 614-4000 170 453072 EAST TEXAS MED CTR REHAB HOSP 701 OLYMPIC PLAZA CIR TYLER TX 75701 (903) 596-3000 892 453080 LIFECARE HOSPITALS OF SOUTH TEXAS INC 333 WEST FREDDY GONZALES DRIVE STE 20EDINBURG TX 78539 (956) 388-1800 650 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 134 Provider ID Hospital Name Address City State ZIP Telephone County 453083 VICTORIA WARM SPRINGS REHAB HOSPITAL 102 MEDICAL DRIVE VICTORIA TX 77904 (512) 572-9276 948 453085 CORNERSTONE REHABILITATION 2655 CORNESTONE BLVD EDINBURG TX 78539 (956) 686-0411 650 453086 HIGHLANDS REGIONAL REHABILITATION HOS 1395 GEORGE DIETER EL PASO TX 79936 (915) 298-7222 480 453088 WICHITA VALLEY REHABILITATION HOSPITAL 300 LOOP 11 WICHITA FALLS TX 76306 (940) 397-8200 960 453300 COOK FT WORTH CHILDRENS MEDICAL CENTER 801 SEVENTH AVENUE FORT WORTH TX 76104 (817) 885-4000 910 453301 DRISCOLL CHILDRENS HOSPITAL 3533 S ALAMEDA BOX 6530 CORPUS CHRISTI TX 78411 (512) 850-5000 830 453302 CHILDRENS MEDICAL CTR OF DALLAS 1935 MOTOR STREET DALLAS TX 75235 (214) 456-7000 390 453304 TEXAS CHILDRENS HOSP 6621 FANNIN STREET HOUSTON TX 77030 (712) 770-1000 610 453305 CHRISTUS SANTA ROSA CHILDRENS HOSPITAL 519 W HOUSTON ST SAN ANTONIO TX 78207 (512) 228-2011 130 453306 COVENANT CHILDREN HOSPITAL 3610 21ST ST LUBBOCK TX 79410 (806) 725-1011 770 453308 OUR CHILDRENS HOUSE AT BAYLOR 3301 SWISS AVE DALLAS TX 75204 (214) 828-4747 390 453309 BEACON HEALTH WESTCHASE 2929 WOODLAND PARK DRIVE HOUSTON TX 77082 (281) 293-7774 610 454000 BIG SPRING STATE HOSPITAL P O BOX 231 LAMESA HIGHWAY BIG SPRING TX 79721 (915) 267-8216 661 454006 TERRELL STATE HOSP 1200 E BRIN ST BOX 70 TERRELL TX 75160 (972) 524-6452 730 454008 NORTH TEXAS STATE HOSPITAL PO BOX 300 6515 LAKE RD WICHITA FALLS TX 76307 (940) 692-1220 960 454009 RUSK STATE HOSP HWY 69 NORTH P O BOX 318 RUSK TX 75785 (903) 683-3421 281 454011 SAN ANTONIO STATE HOSP STATE SCHOOL 6711 S NEW BRAUNFELS AVE SAN ANTONIO TX 78223 (210) 532-8811 130 454012 BHC MILLWOOD HOSPITAL 1011 NORTH COOPER STREET ARLINGTON TX 76011 (817) 261-3121 910 454014 KERRVILLE STATE HOSP 721 THOMPSON DR BOX 1465 KERRVILLE TX 78028 (512) 896-2211 734 454018 RED RIVER HOSPITAL 1505 8TH ST WICHITA FALLS TX 76301 (940) 322-3171 960 454026 WEST OAKS HOSPITAL INC 6500 HORNWOOD HOUSTON TX 77074 (713) 995-0909 610 454029 SETON SHOAL CREEK 3501 MILLS AVE AUSTIN TX 78731 (512) 452-0361 940 454032 DE PAUL CENTER 301 LONDONBERRY DR WACO TX 76702 (254) 772-3500 780 454049 DESERT SPRINGS MEDICAL CENTER 3300 S FM 1788 MIDLAND TX 79703 (915) 563-1200 794 454050 GLEN OAKS HOSPITAL 301 E DIVISION BOX 1885 GREENVILLE TX 75401 (903) 454-6000 670 454060 LAUREL RIDGE A BROWN SCHOOLS PSY HOSP 17720 CORPORATE WOODS DRIVE SAN ANTONIO TX 78259 (512) 491-9400 130 454063 CYPRESS CREEK HOSPITAL INC 17750 CALI DRIVE HOUSTON TX 77090 (713) 586-7600 610 454064 RIVER CREST HOSP 1636 HUNTERS GLEN ROAD SAN ANGELO TX 76901 (915) 949-5722 930 454065 CEDARS HOSPITAL,THE 2000 N OLD HICKORY TRAIL DESOTO TX 75115 (972) 298-7323 390 454069 ST DAVIDS PAVILLION 919 EAST 32ND STREET AUSTIN TX 78765 (512) 867-5800 940 454071 REGIONAL HOSPITAL OF TEXOMA 2601 CORNERSTONE SHERMAN TX 75090 (903) 868-3600 564 454076 HARRIS CTY PSYCHIATRIC CTR 2800 MACGREGOR WAY HOUSTON TX 77021 (713) 741-5000 610 454078 MISSION VISTA HOSPITAL CO 14747 JONES MALTSBERGER SAN ANTONIO TX 78247 (210) 490-0000 130 454081 TIMBERLAWN MENTAL HEALTH SYSTEM 4600 SAMUELL BLVD PO BOX 151489 DALLAS TX 75315 (214) 381-7181 390 454083 INTRACARE NORTH HOSPITAL 1120 CYPRESS STATION DR HOUSTON TX 77090 (713) 893-7200 610 454084 AUSTIN STATE HOSPITAL 4110 GUADALUPE AUSTIN TX 78751 (512) 419-2100 940 454085 DEVEREUX TEXAS TREATMENT NETWORK 1150 DEVEREUX DR LEAGUE CITY TX 77573 (281) 335-1000 550 454088 RIO GRANDE STATE CENTER 1401 RANGERVILLE ROAD HARLINGEN TX 78550 (210) 425-8900 240 454089 INTRACARE MEDICAL CTR 7601 FANNIN HOUSTON TX 77054 (713) 790-0949 610 454092 EL PASO PSYCHIATRIC CENTER 4615 ALAMEDA AVE EL PASO TX 79905 (915) 521-7789 480 454093 SUNRISE CANYON HOSPITAL 1950 ASPEN AVENUE LUBBOCK TX 79408 (806) 740-1400 770 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 135 Provider ID Hospital Name Address City State ZIP Telephone County 454094 GREEN OAKS HOSPITAL 7808 CLODUS FIELDS DRIVE DALLAS TX 75251 (972) 770-0850 390 454096 PADRE BEHAVIORAL HEALTH SYSTEM 6629 WOOLDRIDGE RD CORPUS CHRISTI TX 78414 (361) 986-9444 830 454097 NCED MENTAL HEALTH CENTER 1900 DENVER AVENUE EL PASO TX 79902 (915) 544-4000 480 454098 ABILENE PSYCHIATRIC HOSPITAL 4225 WOODS PLACE ABILENE TX 79608 (915) 698-6600 911 454099 KINGWOOD HEALTH CENTER 2002 LADBROOK KINGWOOD TX 77339 (281) 358-1495 610 460001 UTAH VALLEY REGIONAL MEDICAL CENTER 1034 NORTH 500 WEST PROVO UT 84603 (801) 373-7850 240 460003 SALT LAKE REGIONAL MEDICAL CENTER 1050 EAST SO TEMPLE SALT LAKE CITY UT 84102 (801) 350-4111 170 460004 MCKAY-DEE HOSPITAL CENTER 4401 HARRISON BLVD OGDEN UT 84403 (801) 627-2800 280 460005 OGDEN REGIONAL MEDICAL CENTER 5475 SOUTH 500 EAST OGDEN UT 84405 (801) 479-2111 280 460006 COTTONWOOD HOSPITAL 5770 S 300 E MURRAY UT 84107 (801) 314-5300 170 460007 VALLEY VIEW MEDICAL CENTER 595 SOUTH 75 EAST CEDAR CITY UT 84720 (435) 586-6587 100 460008 PIONEER VALLEY HOSPITAL 3460 SOUTH PIONEER PARKWAY WEST VALLEY UT 84120 (801) 964-3100 170 460009 UNIVERSITY OF UTAH HOSPITAL 50 N MEDICAL DR SALT LAKE CITY UT 84132 (801) 581-2121 170 460010 LDS HOSPITAL 8TH AVENUE & C STREET SALT LAKE CITY UT 84143 (801) 408-1100 170 460011 CASTLEVIEW HOSPITAL 300 NORTH HOSPITAL DR PRICE UT 84501 (801) 637-4800 30 460013 MOUNTAIN VIEW HOSPITAL 1000 EAST 100 NORTH PAYSON UT 84651 (801) 465-7100 240 460014 MOUNTAIN WEST MEDICAL CENTER 2055 NORTH MAIN STREET TOOELE UT 84074 (435) 843-3600 220 460015 LOGAN REGIONAL HOSPITAL 1400 NORTH 500 EAST LOGAN UT 84341 (435) 716-1000 20 460016 ALLEN MEMORIAL HOSPITAL 719 WEST 4TH NORTH MOAB UT 84532 (435) 259-7191 90 460017 BRIGHAM CITY COMMUNITY HOSP 950 S MEDICAL DRIVE BRIGHAM CITY UT 84302 (435) 734-9471 10 460018 KANE COUNTY HOSPITAL 355 NORTH MAIN KANAB UT 84741 (435) 644-5811 120 460019 UINTAH BASIN MEDICAL CENTER 250 WEST 300 NORTH ROOSEVELT UT 84066 (801) 722-4691 60 460020 SAN JUAN HOSPITAL 364 WEST 100 NORTH MONTICELLO UT 84535 (435) 587-2116 180 460021 DIXIE REGIONAL MEDICAL CENTER 544 SOUTH 400 EAST ST GEORGE UT 84770 (435) 688-4000 260 460023 AMERICAN FORK HOSPITAL 170 NORTH 1100 EAST AMERICAN FORK UT 84003 (801) 763-3300 240 460025 MILFORD VALLEY MEMORIAL HOSPITAL 451 MAIN ST MILFORD UT 84751 (435) 387-2411 0 460026 SEVIER VALLEY HOSPITAL 1100 N MAIN RICHFIELD UT 84701 (435) 896-8271 200 460029 SANPETE VALLEY HOSPITAL 1100 S MEDICAL DR MOUNT PLEASANT UT 84647 (435) 462-2441 190 460030 ASHLEY VALLEY MEDICAL CENTER 151 WEST 200 NORTH VERNAL UT 84078 (435) 789-3342 230 460032 CENTRAL VALLEY MEDICAL CENTER 48 WEST 1500 NORTH NEPHI UT 84648 (435) 623-3000 110 460033 GARFIELD MEMORIAL HOSPITAL 200 N 400 E PANGUITCH UT 84759 (435) 676-8811 80 460035 BEAVER VALLEY HOSPITAL 1109 NORTH 100 WEST BEAVER UT 84713 (435) 438-7100 0 460036 HEBER VALLEY MEDICAL CENTER 1485 SOUTH HIGHWAY 40 HEBER CITY UT 84032 (435) 654-2500 250 460037 GUNNISON VALLEY HOSPITAL 60 EAST 100 NORTH GUNNISON UT 84634 (435) 528-7246 190 460039 BEAR RIVER VALLEY HOSPITAL 440 W 600 N TREMONTON UT 84337 (435) 257-7441 10 460041 DAVIS HOSPITAL AND MEDICAL CENTER 1600 WEST ANTELOPE DRIVE LAYTON UT 84041 (801) 825-9561 50 460042 LAKEVIEW HOSPITAL 630 EAST MEDICAL DRIVE BOUNTIFUL UT 84010 (801) 299-2530 50 460043 OREM COMMUNITY HOSPITAL 331 NORTH 400 WEST OREM UT 84057 (801) 224-4080 240 460044 ALTA VIEW HOSPITAL 9660 SOUTH 1300 EAST SANDY UT 84070 (801) 501-2600 170 460047 ST MARK'S HOSPITAL 1200 EAST 3900 SOUTH SALT LAKE CITY UT 84124 (801) 268-7700 170 460049 ORTHOPEDIC SPECIALTY HOSPITAL, THE 5848 SOUTH 300 EAST SALT LAKE CITY UT 84107 (801) 314-4100 170 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 136 Provider ID Hospital Name Address City State ZIP Telephone County 460051 JORDAN VALLEY HOSPITAL 3580 WEST 9000 SOUTH WEST JORDAN UT 84088 (801) 561-8888 170 460052 TIMPANOGOS REGIONAL HOSPITAL 750 WEST 800 NORTH OREM UT 84057 (801) 714-6800 240 460054 CACHE VALLEY SPECIALITY HOSPITAL 2380 NORTH 400 EAST NORTH LOGAN UT 84341 (435) 713-9700 20 461300 DELTA COMMUNITY MEDICAL CENTER 126 SOUTH WHITE SAGE AVE DELTA UT 84624 (435) 864-5591 130 461301 FILLMORE COMMUNITY MEDICAL CENTER 674 SOUTH HIGHWAY 99 FILLMORE UT 84631 (435) 743-5591 130 462003 SOUTH DAVIS COMMUNITY HOSPITAL 401 SOUTH 400 EAST BOUNTIFUL UT 84010 (801) 295-2361 50 463025 HEALTHSOUTH REHAB HOSPITAL OF UTAH 8074 SOUTH 1300 EAST SANDY UT 84091 (801) 561-3400 170 463026 SALT LAKE SPECIALTY MEDICAL CENTER 3460 SOUTH PIONEER PARKWAY WEST VALLEY CITY UT 84120 (801) 964-3550 180 463301 PRIMARY CHILDRENS MEDICAL CENTER 100 NORTH MEDICAL DR SALT LAKE CITY UT 84113 (801) 588-3710 170 464001 UTAH STATE HOSPITAL-PSYCHIATRIC 1300 EAST CENTER STREET PO BOX 270 PROVO UT 84606 (801) 344-4200 280 464009 UNIVERSITY OF UTAH NEUROPSYCHIATRIC IN 501 CHIPETA WAY SALT LAKE CITY UT 84108 (801) 583-2500 170 464011 COPPER HILLS YOUTH CENTER 5899 WEST RIVENDELL DRIVE WEST JORDAN UT 84088 (801) 561-3377 170 470001 CENTRAL VERMONT HOSPITAL BOX 547 BARRE VT 5641 (802) 229-9121 110 470003 FLETCHER ALLEN HOSPITAL OF VERMONT COLCHESTER AVE BURLINGTON VT 5401 (802) 656-2345 30 470005 RUTLAND REGIONAL MEDICAL CENTER 160 ALLEN ST RUTLAND VT 5701 (802) 775-7111 100 470006 PORTER MEDICAL CENTER INC SOUTH ST MIDDLEBURY VT 5753 (802) 388-4701 0 470008 NORTH COUNTRY HOSPITAL & HLTH CENTER PROUTY DRIVE NEWPORT VT 5855 (802) 334-7331 90 470010 COPLEY HOSPITAL 528 WASHINGTON HIGHWAY MORRISVILLE VT 5661 (802) 888-8311 70 470011 BRATTLEBORO MEMORIAL HOSPITAL 9 BELMONT AVE BRATTLEBORO VT 5301 (802) 257-0341 120 470012 SOUTHWESTERN VERMONT MEDICAL CENTER 100 HOSPITAL DR EAST BENNINGTON VT 5201 (802) 442-6361 10 470018 SPRINGFIELD HOSPITAL INC 25 RIDGEWOOD ROAD SPRINGFIELD VT 5156 (802) 885-2151 130 470023 NORTHEASTERN VERMONT REG HOSPITAL HOSPITAL DR SAINT JOHNSBURY VT 5819 (802) 748-8141 20 470024 NORTHWESTERN MEDICAL CENTER INC 133 FAIRFIELD ST PO BOX 1370 SAINT ALBANS VT 5478 (802) 524-5911 50 471300 GRACE COTTAGE HOSPITAL PO BOX 216 TOWNSHEND VT 5353 (802) 365-7920 120 471301 GIFFORD MEDICAL CENTER 44 SOUTH MAIN STREET RANDOLPH VT 5060 (802) 728-4441 80 471302 MT ASCUTNEY HOSPITAL RR 1 BOX 6 COUNTY ROAD WINDSOR VT 5089 (802) 674-6711 130 474001 BRATTLEBORO RETREAT ANNA MARSH LANE PO BOX 803 BRATTLEBORO VT 5301 (802) 257-7785 120 474002 VERMONT STATE HOSP DISTINCT PART UNIT 103 SOUTH MAIN ST WATERBURY VT 5676 (802) 241-3100 110 480001 ROY LESTER SCHNEIDER HOSPITAL,THE 9048 SUGAR ESTATE SAINT THOMAS VI 801 (809) 776-8311 20 480002 GOV JUAN F LUIS HOSPITAL & MEDICAL CTR #4007 EST DIAMOND RUBY, CHRISTIANSTED ST CROIX VI 820 (809) 778-6311 10 490001 NORTON COMMUNITY HOSPITAL 100 15TH ST NW NORTON VA 24273 (703) 679-9600 661 490002 RUSSELL CNTY MED CNTR CARROL TATE STS LEBANON VA 24266 (540) 889-1224 830 490004 ROCKINGHAM MEMORIAL HOSPITAL 235 CANTRELL AVE HARRISONBURG VA 22801 (703) 433-4100 421 490005 WINCHESTER MEDICAL CENTER INC 1840 AMHERST ST WINCHESTER VA 22601 (703) 722-8000 962 490006 SHENANDOAH COUNTY MEMORIAL HOSPITAL P O BOX 508 ROUTE 11 WOODSTOCK VA 22664 (703) 459-4021 850 490007 SENTARA NORFOLK GENL HOSP 600 GRESHAM DR NORFOLK VA 23507 (804) 628-3361 641 490009 UNIV OF VA HOSP JEFFERSON PARK AVE CHARLOTTESVILLE VA 22901 (804) 924-8324 10 490011 BON SECOURS - DEPAUL MEDICAL CENTER 150 KINGSLEY LANE NORFOLK VA 23505 (804) 489-5000 641 490012 LEE REGIONAL MEDICAL CENTER POST OFFICE BOX 70 1800 COMBS ROAD PENNINGTON GAP VA 24277 (540) 546-1440 520 490013 HALIFAX-SOUTH BOSTON COMM HOSP 2204 WILBORN AVENUE HALIFAX VA 24558 (804) 575-3100 410 490015 HEALTHSOUTH MEDICAL CENTER 7700 PARHAM RD RICHMOND VA 23294 (804) 747-5615 430 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 137 Provider ID Hospital Name Address City State ZIP Telephone County 490017 MARYVIEW MEDICAL CENTER/PORTSMOUTH GEN STREET PORTSMOUTH VA 23707 (804) 398-2200 711 490018 AUGUSTA MEDICAL CENTER 96 MEDICAL CENTER DRIVE FISHERSVILLE VA 22939 (540) 932-4000 891 490019 CULPEPER MEMORIAL HOSPITAL INC 501 SUNSET LANE CULPEPER VA 22701 (703) 829-4300 230 490020 COLUMBIA JOHN RANDOLPH MEDICAL CENTER` 411 W RANDOLPH ROAD HOPEWELL VA 23860 (804) 541-1600 451 490021 VIRGINIA BAPTIST HOSP & LYNCHBURG GENL 3300 RIVERMONT AVE LYNCHBURG VA 24503 (804) 947-4000 551 490022 MARY WASHINGTON HOSPITAL 1001 SAM PERRY BOULEVARD FREDERICKSBURG VA 22401 (703) 899-1100 880 490023 FAUQUIER HOSP 500 HOSPITAL DR WARRENTON VA 22186 (703) 347-2550 300 490024 CARILION MEDICAL CENTER BELLEVIEW & JEFFERSON STS PO BOX 1336 ROANOKE VA 24014 (703) 981-7000 801 490027 ST MARYS HOSPITAL THIRD STREET NE NORTON VA 24273 (703) 679-9100 661 490031 STONEWALL JACKSON HOSPITAL 102 SPOTSWOOD ROAD LEXINGTON VA 24450 (703) 643-9141 522 490032 MEDICAL COLLEGE OF VIRGINIA HOSPITALS 401 N 12TH ST, MCV STATION BOX 510 RICHMOND VA 23298 (804) 786-9000 791 490033 WARREN MEMORIAL HOSP 1000 SHENANDOAH AVE FRONT ROYAL VA 22630 (703) 636-0300 930 490035 NEWPORT NEWS GENERAL HOSPITAL 5100 MARSHALL AVE NEWPORT NEWS VA 23605 (804) 247-7200 622 490037 SHORE MEMORIAL HOSPITAL 9507 HOSPITAL AVENUE PO BOX 17 NASSAWADOX VA 23413 (804) 442-8000 650 490038 SMYTH COUNTY COMM HOSP 700 PARK BLVD MARION VA 24354 (703) 123-4141 860 490040 INOVA ALEXANDRIA HOSPITAL 4320 SEMINARY RD ALEXANDRIA VA 22304 (703) 379-3000 11 490041 MARY IMMACULATE HOSP 800 DENBIGH BLVD NEWPORT NEWS VA 23602 (804) 886-6000 622 490042 CARILION RADFORD COMMUNITY HOSPITAL 700 RANDOLPH STREET RADFORD VA 24141 (703) 731-2000 771 490043 LOUDOUN HOSPITAL CENTER, LANSDOWNE 44045 RIVERSIDE PARKWAY LEESBURG VA 20176 (703) 777-3300 530 490044 LOUISE OBICI MEMORIAL HOSPITAL 2800 GODWIN BOULEVARD SUFFOLK VA 23439 (804) 934-4000 892 490045 PRINCE WILLIAM HOSP 8700 SUDLEY RD MANASSAS VA 20110 (703) 369-8350 751 490046 SENTARA LEIGH HOSPITAL 830 KEMPSVILLE RD NORFOLK VA 23507 (804) 466-6601 641 490047 PAGE MEMORIAL HOSPITAL INC 200 MEMORIAL DR LURAY VA 22835 (703) 743-4561 690 490048 COLUMBIA LEWIS-GALE MEDICAL CENTER 1900 ELECTRIC ROAD SALEM VA 24153 (703) 989-4251 838 490050 ARLINGTON HOSPITAL 1701 NORTH GEORGE MASON DRIVE ARLINGTON VA 22205 (703) 558-6104 60 490052 RIVERSIDE REGIONAL MEDICAL CENTER 500 J CLYDE MORRIS BLVD NEWPORT NEWS VA 23601 (804) 594-2020 622 490053 JOHNSTON MEMORIAL HOSPITAL 351 N COURT ST ABINGDON VA 24210 (703) 676-7000 950 490054 PATRICK COMMUNITY HOSPITAL ROUTE #2 BOX 71 STUART VA 24171 (703) 694-3151 700 490057 VIRGINIA BEACH GENERAL HOSPITAL 1060 FIRST COLONIAL RD VIRGINIA BEACH VA 23454 (804) 481-8448 921 490059 ST MARYS HOSPITAL OF RICHMOND 5801 BREMO RD RICHMOND VA 23226 (804) 281-8206 430 490060 CLINCH VALLEY MEDICAL CENTER 2949 W FRONT ST RICHLANDS VA 24641 (703) 963-0811 920 490063 INOVA FAIRFAX HOSPITAL 3300 GALLOWS RD FALLS CHURCH VA 22042 (703) 698-1110 291 490066 WILLIAMSBURG COMMUNITY HOSPITAL 1238 MOUNT VERNON AVENUE WILLIAMSBURG VA 23185 (804) 253-6010 981 490067 SOUTHSIDE REGIONAL MEDICAL CENTER 801 S ADAMS STREET PETERSBURG VA 23803 (804) 862-5000 701 490069 BON SECOURS-MEMORIAL REGIONAL MEDICAL 8260 ATLEE ROAD MECHANICSVILLE VA 23116 (804) 254-6000 430 490071 COLUMBIA RETREAT HOSPITAL 2621 GROVE AVENUE RICHMOND VA 23220 (804) 254-5100 791 490073 NORTHERN VIRGINIA COMMUNITY HOSPITAL 601 SOUTH CARLIN SPRINGS ROAD ARLINGTON VA 22204 (703) 671-1200 60 490075 DANVILLE REGIONAL MEDICAL CENTER 142 S MAIN ST DANVILLE VA 24541 (804) 799-2100 241 490077 MARTHA JEFFERSON HOSPITAL 459 LOCUST AVE CHARLOTTESVILLE VA 22901 (804) 982-7000 10 490079 MEMORIAL HOSP MARTINSVILLE 320 HOSPITAL DRIVE MARTINSVILLE VA 24115 (703) 666-7200 561 490084 RIVERSIDE TAPPAHANNOCK HOSP INC ROUTE 2 BOX 612 TAPPAHANNOCK VA 22560 (804) 443-3311 280 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 138 Provider ID Hospital Name Address City State ZIP Telephone County 490088 CARILION BEDFORD MEMORIAL HOSPITAL 1613 OAKWOOD STREET BOX 688 BEDFORD VA 24523 (703) 586-2441 88 490089 CARILION FRANKLIN MEMORIAL HOSPITAL 124 FLOYD AVENUE ROCKY MOUNT VA 24151 (703) 483-5277 330 490090 SOUTHSIDE COMMUNITY HOSPITAL 800 OAK ST FARMVILLE VA 23901 (804) 392-8811 730 490091 BON SECOURS-STUART CIRCLE HOSPITAL 413-21 STUART CIRCLE RICHMOND VA 23220 (804) 358-7051 791 490092 SOUTHAMPTON MEMORIAL HOSPITAL 100 FAIRVIEW DR FRANKLIN VA 23851 (804) 569-6100 328 490093 SENTARA HAMPTON GENL HOSP 3120 VICTORIA BLVD HAMPTON VA 23669 (804) 727-7554 411 490094 RICHMOND COMMUNITY HOSPITAL 1500 N 28TH ST RICHMOND VA 23223 (804) 225-1700 791 490097 GREENSVILLE MEMORIAL HOSPITAL 214 WEAVER AVE EMPORIA VA 23847 (804) 348-2000 270 490098 COMMUNITY MEM HEALTH CENTER 125 BUENA VISTA CIRCLE SOUTH HILL VA 23970 (434) 447-3151 580 490101 INOVA FAIR OAKS HOSPITAL 3600 JOSEPH DIEWICK DR FAIRFAX VA 22033 (703) 391-3600 290 490104 HIRAM W DAVIS MEDICAL CENTER P O BOX 4030 PETERSBURG VA 23803 (804) 524-7344 701 490105 SOUTHWESTERN VA MENTAL HEALTH INST 502 EAST MAIN STREET MARION VA 24354 (703) 783-1200 860 490106 WESTERN STATE HOSP PO BOX 2500 STAUNTON VA 24401 (703) 332-8000 891 490107 RESTON HOSPITAL CENTER 1850 TOWN CENTER PKWY PO BOX 3220 RESTON VA 22090 (703) 689-9000 290 490108 CENTRAL VIRGINIA TRAINING CENTER PO BOX 1098 LYNCHBURG VA 24505 (804) 947-6000 551 490109 EASTERN STATE HOSPITAL 4601 IRONBOUND ROAD, PO BOX 8791 WILLIAMSBURG VA 23185 (804) 253-5161 981 490110 MONTGOMERY REGIONAL HOSPITAL ROUTE 460 SOUTH BLACKSBURG VA 24060 (703) 953-5101 600 490111 WYTHE COUNTY COMM HOSP 600 W RIDGE RD WYTHEVILLE VA 24382 (703) 228-0200 980 490112 CHIPPENHAM MEDICAL CENTER 1401 JOHNSTON WILLIS DRIVE RICHMOND VA 23235 (804) 323-8800 791 490113 POTOMAC HOSPITAL 2300 OPITZ BOULEVARD WOODBRIDGE VA 22191 (703) 670-1313 750 490114 WELMONT LONESOME PINE HOSPITAL 1990 HOLTON AVENUE EAST PO DRAWER 1 BIG STONE GAP VA 24219 (703) 523-3111 970 490115 TWIN COUNTY REGIONAL HOSPITAL 200 HOSPITAL DRIVE GALAX VA 24333 (703) 236-8181 343 490116 PULASKI COMMUNITY HOSPITAL 2400 LEE HIGHWAY PULASKI VA 24301 (703) 980-6822 600 490117 TAZEWELL COMMUNITY HOSP 141 BEN BOLT AVENUE TAZEWELL VA 24651 (276) 988-8706 920 490118 HENRICO DOCTORS HOSPITAL FOREST 1602 SKIPWITH ROAD RICHMOND VA 23229 (804) 289-4500 430 490119 SENTARA BAYSIDE HOSPITAL 800 INDEPENDENCE BLVD VIRGINIA BEACH VA 23455 (804) 363-6196 921 490120 CHESAPEAKE GENERAL HOSPITAL 736 BATTLEFIELD BLVD N CHESAPEAKE VA 23320 (804) 547-8121 194 490122 MT VERNON HOSPITAL 2501 PARKERS LANE ALEXANDRIA VA 22306 (703) 664-7105 290 490123 RAPPAHANNOCK GENL HOSP HARRIS DRIVE PO BOX 1449 KILMARNOCK VA 22482 (804) 435-8000 510 490124 CAPITOL MEDICAL CENTER 700 WEST GRACE ST RICHMOND VA 23220 (804) 775-4100 791 490126 COLUMBIA ALLEGHENY REGIONAL HOSPITAL 1 ARH LANE P O BOX 7 LOWMOOR VA 24457 (703) 862-6011 20 490127 BUCHANAN GENERAL HOSPITAL ROUTE 5 BOX 20 GRUNDY VA 24614 (703) 935-1000 130 490129 HOSPICE OF NORTHERN VIRGINIA 4715 N 15 ST ARLINGTON VA 22205 (703) 525-7070 60 490130 RIVERSIDE WALTER REED HOSPITAL ROUTE 17 BOX 1130 GLOUCESTER VA 23061 (804) 693-8810 360 490132 DICKENSON COUNTY MEDICAL CENTER PO BOX 1390 HOSPITAL DRIVE CLINTWOOD VA 24228 (540) 926-0300 250 491300 BATH COUNTY COMMUNITY HOSPITAL RURAL ROUTE 220 PO DRAWER Z HOT SPRINGS VA 24445 (540) 839-7000 80 491301 R J REYNOLDS PATRICK CO MEMORIAL HOSP 18688 JEB STUART HIGHWAY STUART VA 24171 (540) 694-8651 700 491302 CARILION GILES MEMORIAL HOSPITAL 1 TAYLOR AVENUE PO BOX K PEARISBURG VA 24134 (540) 921-6000 350 491991 LYNN HOUSE OF POTOMAC VALLEY 4400 BRADDOCK ROAD ALEXANDRIA VA 22304 (703) 379-6000 0 492001 LAKE TAYLOR HOSP 1309 KEMPSVILLE RD NORFOLK VA 23502 (804) 461-5001 641 492003 PIEDMONT GERIATRIC HOSP HIGHWAY 360 AND 460 BURKEVILLE VA 23922 (804) 767-4401 670 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 139 Provider ID Hospital Name Address City State ZIP Telephone County 492004 CATAWBA HOSPITAL P O BOX 200 CATAWBA VA 24070 (703) 375-4201 800 492007 HOSPITAL FOR EXTENDED RECOVERY 600 GRESHAM DRIVE SUITE 700 NORFOLK VA 23507 (757) 668-1700 641 493025 SHELTERING ARMS PHYSICAL REHAB HOSP 8254 ATLEE ROAD MECHANICSVILLE VA 23116 (804) 254-6161 430 493026 WOODROW WILSON REHABILITATION CENTER FISHERVILLE CENTER ROUTE 250 FISHERSVILLE VA 22939 (703) 332-7214 70 493027 RIVERSIDE REHAB INSTITUTE 245 CHESAPEAKE AVENUE NEWPORT NEWS VA 23607 (757) 928-8000 622 493028 HEALTHSOUTH REHAB HOSP OF VIRGINIA 5700 FITZHUGH AVENUE RICHMOND VA 23226 (804) 288-5700 430 493029 UVA/HEALTHSOUTH REHABILITATION HOSPITA 515 RAY C HUNT DRIVE CHARLOTTESVILLE VA 22903 (804) 244-2000 191 493300 CUMBERLAND HOSPITAL 9407 CUMBERLAND ROAD PO BOX 150 NEW KENT VA 23124 (804) 966-1650 621 493301 CHILDREN'S HOSP KING'S DAUGHTERS 601 CHILDREN'S LANE NORFOLK VA 23507 (804) 628-7039 641 493302 CHILDREN'S HOSPITAL 2924 BROOK ROAD RICHMOND VA 23220 (804) 321-7474 791 494001 COLUMBIA PENINSULA BEHAVIORIAL CENTER 2244 EXECUTIVE DRIVE HAMPTON VA 23666 (757) 827-1001 411 494002 CARILION ST ALBANS PSYCHIATRIC HOSPITA P O BOX 3608 LEE HIGHWAY RADFORD VA 24141 (540) 639-2481 771 494010 NORTHERN VIRGINIA MENTAL HEALTH INSTI 3302 GALLOWS RD FALLS CHURCH VA 22046 (703) 207-7100 291 494011 NORFOLK PSYCHIATRIC CENTER 860 KEMPSVILLE RD NORFOLK VA 23507 (757) 461-4565 641 494016 CHARTER WESTBROOK BEHAVIOR HLTH SY INC 1500 WESTBROOK AVENUE RICHMOND VA 23227 (804) 266-9671 430 494017 SOUTH VIRGINIA MENTAL HEALTH INSTITUTE 382 TAYLOR DRIVE DANVILLE VA 24541 (804) 799-6220 241 494020 PIEDMONT BEHAVIORAL HEALTH CENTER 42009 VICTORY LANE LEESBURG VA 20176 (703) 777-0800 530 494021 WESTERN STATE HOSPITAL PO BOX 2500 STAUNTON VA 24401 (540) 332-8000 891 494022 POPLAR SPRINGS HOSPITAL 350 POPLAR DRIVE PO BOX 3060 PETERSBURG VA 23805 (804) 733-6874 701 494023 DOMINION HOSP 2960 SLEEPY HOLLOW RD FALLS CHURCH VA 22044 (703) 536-2000 290 494025 VIRGINIA BEACH PSYCHIATRIC CENTER 1100 FIRST COLONIAL ROAD VIRGINIA BEACH VA 23454 (757) 496-6000 921 494026 VALUEMARK WESTEND BEHAVIOR HEALTH SYST 12800 WEST CREEK PARKWAY RICHMOND VA 23238 (804) 784-2200 430 494028 SNOWDEN AT FREDERICKSBURG INC 1200 SAM PERRY BOULEVARD FREDERICKSBURG VA 22401 (703) 372-3900 880 494029 SOUTHWESTERN VA MENTAL HEALTH INSTITUT 502 EAST MAIN STREET MARION VA 24354 (703) 783-1200 860 494030 EASTERN STATE HOSPITAL 4601 IRONBOUND ROAD WILLIAMSBURG VA 23187 (757) 253-5241 961 494031 WOODSIDE HOSPITAL,LLC 17579 WARWICK BOULEVARD NPRT NWS VA 23603 (757) 888-0400 622 500001 NORTHWEST HOSPITAL 1550 NORTH 115TH STREET/BOX 330333 SEATTLE WA 98133 (206) 364-0500 160 500002 ST MARY MEDICAL CENTER 401 W POPLAR ST/PO BOX 1477 WALLA WALLA WA 99362 (509) 525-3320 350 500003 AFFILIATED HEALTH SERVICES 1415 EAST KINCAID STREET/PO BOX 1376 MOUNT VERNON WA 98273 (360) 424-4111 280 500005 VIRGINIA MASON MEDICAL CENTER 925 SENECA STREET/PO BOX 1930 SEATTLE WA 98111 (206) 223-6600 160 500007 ISLAND HOSPITAL 1211 24TH STREET ANACORTES WA 98221 (360) 299-1300 280 500008 UNIVERSITY OF WASHINGTON MEDICAL CTR 1959 NE PACIFIC ST/BOX 356151 SEATTLE WA 98195 (206) 598-4640 160 500011 HIGHLINE COMMUNITY HOSPITAL 16251 SYLVESTER ROAD SW BURIEN WA 98166 (206) 244-9970 160 500012 PROVIDENCE YAKIMA MEDICAL CENTER 110 SOUTH NINTH AVE YAKIMA WA 98902 (509) 575-5000 380 500014 PROVIDENCE EVERETT MEDICAL CENTER 1321 COLBY AVENUE/PO BOX 1147 EVERETT WA 98206 (425) 261-3916 300 500015 AUBURN REGIONAL MEDICAL CENTER 202 N DIVISION / PLAZA ONE AUBURN WA 98001 (253) 833-7711 160 500016 CENTRAL WASHINGTON HOSPITAL 1300 FULLER STREET/PO BOX 1887 WENATCHEE WA 98801 (509) 662-1511 30 500019 PROVIDENCE CENTRALIA HOSPITAL 914 S SCHEUBER ROAD CENTRALIA WA 98531 (360) 736-2803 200 500021 SAINT CLARE HOSPITAL 11315 BRIDGEPORT WAY S W LAKEWOOD WA 98499 (253) 588-1711 260 500023 LOURDES MEDICAL CENTER 520 NORTH FOURTH AVE/PO BOX 2568 PASCO WA 99301 (509) 547-7704 100 500024 PROVIDENCE ST PETER HOSPITAL 413 N LILLY ROAD OLYMPIA WA 98506 (360) 491-9480 330 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 140 Provider ID Hospital Name Address City State ZIP Telephone County 500025 SWEDISH MEDICAL CENTER/PROVIDENCE 500 17TH AVE/PO BOX C-34008 SEATTLE WA 98124 (206) 320-2000 160 500026 STEVENS HOSPITAL 21601 76TH AVENUE WEST EDMONDS WA 98026 (425) 640-4001 300 500027 SWEDISH MEDICAL CENTER 747 BROADWAY SEATTLE WA 98122 (206) 386-6000 160 500028 NORTH VALLEY HOSPITAL 16 WEST SECOND(BOX 488) TONASKET WA 98855 (509) 486-2151 230 500030 ST JOSEPHS HOSPITAL 2901 SQUALICUM PARKWAY BELLINGHAM WA 98225 (360) 734-5400 360 500031 GRAYS HARBOR COMMUNITY HOSPITAL 915 ANDERSON DRIVE ABERDEEN WA 98520 (360) 532-8330 130 500033 SAMARITAN HOSPITAL 801 EAST WHEELER ROAD MOSES LAKE WA 98837 (509) 765-5606 120 500036 YAKIMA VALLEY MEMORIAL HOSPITAL 2811 TIETON DRIVE YAKIMA WA 98902 (509) 575-8000 380 500037 PROVIDENCE TOPPENSIH HOSPITAL 502 W FOURTH AVE/PO BOX 672 TOPPENISH WA 98948 (509) 865-3105 380 500039 HARRISON MEMORIAL HOSPITAL 2520 CHERRY AVENUE BREMERTON WA 98310 (360) 377-3911 170 500041 PEACEHEALTH ST JOHN MEDICAL CENTER 1615 DELAWARE STREET (P O BOX 3002) LONGVIEW WA 98632 (360) 414-2000 70 500044 DEACONESS MEDICAL CENTER W 800 FIFTH AVENUE/PO BOX 248 SPOKANE WA 99210 (509) 458-5800 310 500049 WALLA WALLA GENERAL HOSPITAL 1025 S SECOND AVE/PO BOX 1398 WALLA WALLA WA 99362 (509) 525-0480 350 500050 S W WASHINGTON MEDICAL CENTER 600 NE 92ND AVENUE, P O BOX 1600 VANCOUVER WA 98668 (360) 256-2000 50 500051 OVERLAKE HOSPITAL MEDICAL CENTER 1035-116TH AVE NE BELLEVUE WA 98004 (425) 688-5000 160 500052 GROUP HEALTH EASTSIDE HOSPITAL 2700 152ND NE REDMOND WA 98052 (425) 883-5151 160 500053 KENNEWICK GENERAL HOSPITAL 900 SOUTH AUBURN ST/PO BOX 6128 KENNEWICK WA 99336 (509) 586-6111 20 500054 SACRED HEART MEDICAL CENTER WEST 101 8TH AVE/PO BOX 2555 SPOKANE WA 99220 (509) 474-3131 310 500055 MOUNT CARMEL HOSPITAL 982 EAST COLUMBIA/PO BOX 351 COLVILLE WA 99114 (509) 684-2561 320 500057 TRI-STATE MEMORIAL HOSPITAL 1221 HIGHLAND AVE (P O BOX 189) CLARKSTON WA 99403 (509) 758-5511 10 500058 KADLEC MEDICAL CENTER 888 SWIFT BLVD RICHLAND WA 99352 (509) 946-4611 20 500059 JEFFERSON GENERAL HOSPITAL 834 SHERIDAN PORT TOWNSEND WA 98368 (360) 385-2200 150 500060 CASCADE VALLEY HOSPITAL 330 S STILLAGUAMISH AVE ARLINGTON WA 98223 (360) 435-2133 300 500062 FORKS COMMUNITY HOSPITAL 530 BOGACHIEL WAY FORKS WA 98331 (360) 374-6271 40 500064 HARBORVIEW MEDICAL CENTER 325 9TH AVENUE (MS359738) SEATTLE WA 98104 (206) 731-3000 160 500065 PULLMAN MEMORIAL HOSPITAL NE 1125 WASHINGTON AVE PULLMAN WA 99163 (509) 332-2541 370 500071 MID-VALLEY HOSPITAL 810 JASMINE STREET, P O BOX 873 OMAK WA 98841 (509) 826-1760 230 500072 OLYMPIC MEDICAL CENTER 939 CAROLINE ST PORT ANGELES WA 98362 (360) 417-7000 40 500074 WHITMAN HOSPITAL & MEDICAL CENTER 1200 W FAIRVIEW RD COLFAX WA 99111 (509) 397-3435 370 500077 HOLY FAMILY HOSPITAL N 5633 LIDGERWOOD SPOKANE WA 99207 (509) 482-0111 310 500079 GOOD SAMARITAN HOSPITAL & REHAB CENTER 407 14TH AVE SE/PO BOX 1247 PUYALLUP WA 98371 (253) 848-6661 260 500084 VALLEY GENERAL HOSPITAL 14701 179TH SE/PO BOX 646 MONROE WA 98272 (360) 794-7497 300 500086 SUNNYSIDE COMMUNITY HOSPITAL 1016 TACOMA AVENUE PO BOX 719 SUNNYSIDE WA 98944 (509) 837-1500 380 500088 VALLEY MEDICAL CENTER 400 S 43RD ST RENTON WA 98055 (425) 228-3450 160 500092 LAKE CHELAN COMMUNITY HOSPITAL 503 E HIGHLAND/PO BOX 908 CHELAN WA 98816 (509) 682-2531 30 500098 FERRY COUNTY MEMORIAL HOSPITAL 36 N KLONDIKE RD REPUBLIC WA 99166 (509) 775-3333 90 500104 ENUMCLAW COMMUNITY HOSPITAL 1450 BATTERSBY AVE/PO BOX 218 ENUMCLAW WA 98022 (360) 825-2505 160 500107 OKANOGAN-DOUGLAS DISTRICT HOSPITAL 577 HOSPITAL WAY, P O BOX 577 BREWSTER WA 98812 (509) 689-2517 230 500108 ST JOSEPH MEDICAL CENTER 1717 J STREET/PO BOX 2197 TACOMA WA 98405 (253) 627-4100 260 500110 KITTITAS VALLEY COMMUNITY HOSPITAL 603 S CHESTNUT ELLENSBURG WA 98926 (509) 962-9841 180 500118 MASON GENERAL HOSPITAL 901 MT VIEW DR BLDG 1/PO BOX 1668 SHELTON WA 98584 (360) 426-1611 220 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 141 Provider ID Hospital Name Address City State ZIP Telephone County 500119 VALLEY HOSPITAL & MEDICAL CENTER 12606 EAST MISSION AVENUE SPOKANE WA 99216 (509) 924-6650 310 500122 WHIDBEY GENERAL HOSPITAL 101 N MAIN STREET (PO BOX 400) COUPEVILLE WA 98239 (360) 678-5151 140 500124 EVERGREEN HOSPITAL MEDICAL CENTER 12040 NE 128TH STREET KIRKLAND WA 98034 (425) 899-1000 160 500129 TACOMA GENERAL ALLENMORE HOSPITAL 315 S MLK JR WAY/PO BOX 5299 TACOMA WA 98415 (253) 552-1000 260 500134 SCHICK-SHADEL HOSPITAL 12101 AMBAUM BOULEVARD S W SEATTLE WA 98146 (206) 244-8000 160 500138 SEATTLE CANCER CARE ALLIANCE 825 EASTLAKE SEATTLE WA 98195 (206) 288-1000 160 500139 COLUMBIA CAPITAL MEDICAL CENTER 3900 CAPITAL MALL DR SW/BOX 19002 OLYMPIA WA 98507 (360) 754-5858 330 500140 HOSPICE CARE CENTER HOSPITAL 1035 11TH AVENUE P O BOX 2067 LONGVIEW WA 98632 (360) 425-8510 70 500141 ST FRANCIS COMMUNITY HOSPITAL 34515 - 9TH AVENUE SOUTH FEDERAL WAY WA 98003 (253) 838-9700 160 500143 ST PETER CHEMICAL DEPENDENCY CENTER 4800 COLLEGE ST SE LACEY WA 98503 (360) 459-8811 330 500147 SNOQUALMIE VALLEY HOSPITAL 9575 ETHAN WADE WAY SE SNOQUALMIE WA 98065 (425) 831-2300 160 500148 WENATCHEE VALLEY HOSPITAL 820 NORTH CHELAN STREET WENATCHEE WA 98807 (509) 663-8711 30 501301 GARFIELD COUNTY MEMORIAL HOSPITAL 66 NORTH SIXTH STREET (P O BOX 880) POMEROY WA 99347 (509) 843-1591 110 501302 DAYTON GENERAL HOSPITAL 1012 SOUTH 3RD STREET DAYTON WA 99328 (509) 382-2531 60 501303 WILLAPA HARBOR HOSPITAL 800 ALDER STREET SOUTH BEND WA 98586 (360) 875-5526 240 501304 MARK REED HOSPITAL 322 SOUTH BIRCH STREET MCCLEARY WA 98557 (360) 495-3244 130 501305 LINCOLN HOSPITAL 10 NICHOLLS STREET DAVENPORT WA 99122 (509) 725-7101 210 501306 DEER PARK HOSPITAL 1015 EAST D STREET, P O BOX 742 DEER PARK WA 99006 (509) 276-5061 310 501307 ODESSA MEMORIAL HOSPITAL 502 E AMENDE DRIVE ODESSA WA 99159 (509) 982-2611 210 501308 COULEE COMMUNITY HOSPITAL 411 FORTUYN ROAD GRAND COULEE WA 99133 (509) 633-1753 120 501309 ST JOSEPH'S HOSPITAL OF CHEWELAH 500 EAST WEBSTER CHEWELAH WA 99109 (509) 935-8211 320 501310 NEWPORT COMMUNITY HOSPITAL WEST 714 PINE STREET NEWPORT WA 99156 (509) 447-2441 250 501311 EAST ADAMS RURAL HOSPITAL 903 SOUTH ADAMS RITZVILLE WA 99169 (509) 659-5402 0 501312 PROSSER MEMORIAL HOSPITAL 723 MEMORIAL STREET PROSSER WA 99350 (509) 786-6605 20 501313 CASCADE MEDICAL CENTER 817 COMMERCIAL STREET LEAVENWORTH WA 98826 (509) 548-5815 30 501314 OCEAN BEACH HOSPITAL 174 FIRST AVENUE NORTH ILWACO WA 98624 (360) 642-3181 240 501315 SKYLINE HOSPITAL 211 SKYLINE DRIVE WHITE SALMON WA 98672 (509) 493-1101 190 501316 KLICKITAT VALLEY HOSPITAL 310 SOUTH ROOSEVELT STREET GOLDENDALE WA 98620 (509) 773-4022 190 501317 COLUMBIA BASIN HOSPITAL 200 SOUTHEAST BOULEVARD EPHRATA WA 98823 (509) 754-4631 120 501318 OTHELLO COMMUNITY HOSPITAL 315 NORTH 14TH AVENUE OTHELLO WA 99344 (509) 488-2636 0 501320 QUINCY VALLEY HOSPITAL 908 10TH AVENUE SOUTHWEST QUINCY WA 98848 (509) 787-3531 120 501992 SUNRISE HAVEN PO BOX 6057 24423 100TH AVENUE SOUTH KENT WA 98064 (253) 813-2096 0 502001 REG HOSP FOR RESP AND COMPLEX CARE 12844 MILITARY ROAD SOUTH TUKWILA WA 98168 (206) 248-4548 160 502002 KINDRED HOSPITAL-SEATTLE 10560 5TH AVENUE NE SEATTLE WA 98125 (206) 364-2050 160 503025 ST LUKE'S REHABILITATION INSTITUTE 711 SOUTH COWLEY SPOKANE WA 99202 (509) 458-7225 310 503300 CHILDREN'S HOSP & REGIONAL MED CTR 4800 SAND POINT WAY NE/BOX C-5371 SEATTLE WA 98105 (206) 526-2000 160 503301 MARY BRIDGE CHILDREN'S HOSPITAL 317 MARTIN LUTHER KING JR W BOX 5299 TACOMA WA 98415 (253) 403-1400 260 504002 FAIRFAX HOSPITAL 10200 NE 132ND STREET KIRKLAND WA 98034 (425) 821-2000 160 504003 WESTERN STATE HOSPITAL 9601 STEILCOOM BLVD SW TACOMA WA 98498 (253) 756-2525 260 504004 EASTERN STATE HOSPITAL MAPLE STREET BOX A MEDICAL LAKE WA 99022 (509) 299-3121 310 504008 LOURDES COUNSELING CENTER 1175 CARONDELET DRIVE RICHLAND WA 99352 (509) 943-9104 20 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 142 Provider ID Hospital Name Address City State ZIP Telephone County 504009 WEST SEATTLE PSYCHIATRIC HOSPITAL 2600 SOUTHWEST HOLDEN SEATTLE WA 98126 (206) 933-7299 160 504010 PUGET SOUND BEHAVIORAL HEALTH 215 SOUTH 36TH STREET TACOMA WA 98418 (253) 798-4500 260 510001 WEST VIRGINIA UNIVERSITY HOSPITALS MEDICAL CENTER DRIVE MORGANTOWN WV 26506 (304) 598-4000 300 510002 GREENBRIER VALLEY MEDICAL CENTER 202 MAPLEWOOD AVENUE PO BOX 497 RONCEVERTE WV 24970 (304) 647-4411 120 510005 PRESTON MEMORIAL HOSPITAL 300 SOUTH PRICE ST KINGWOOD WV 26537 (304) 329-1400 380 510006 UNITED HOSPITAL CENTER PO BOX 1605 CLARKSBURG WV 26301 (304) 624-2332 160 510007 ST MARYS HOSPITAL 2900 1ST AVENUE HUNTINGTON WV 25701 (304) 526-1234 50 510008 CITY HOSPITAL P O BOX 1418 DRY RUN ROAD MARTINSBURG WV 25401 (304) 263-8971 10 510012 PLEASANT VALLEY HOSPITAL 2520 VALLEY DRIVE POINT PLEASANT WV 25550 (304) 675-4340 260 510013 REYNOLDS MEMORIAL HOSPITAL 800 WHEELING AVE GLEN DALE WV 26038 (304) 845-3211 250 510015 BOONE MEMORIAL HOSPITAL 701 MADISON AVE MADISON WV 25130 (304) 369-1230 20 510018 JACKSON GENERAL HOSPITAL PINNELL ST RIPLEY WV 25271 (304) 372-2731 170 510022 CHARLESTON AREA MED CNTR 501 MORRIS STREET CHARLESTON WV 25301 (304) 348-5432 190 510023 WEIRTON MEDICAL CENTER 601 COLLIERS WAY WEIRTON WV 26062 (304) 797-6000 140 510024 MONONGALIA COUNTY GENERAL HOSPITAL 1200 JD ANDERSON DR MORGANTOWN WV 26505 (304) 598-1200 300 510026 GRANT MEM HOSP ROUTE 55 P O BOX 1019 PETERSBURG WV 26847 (304) 257-1026 110 510028 MONTGOMERY GENL HOSP 401 SIXTH AVENUE PO BOX 270 MONTGOMERY WV 25136 (304) 442-5151 90 510029 THOMAS MEMORIAL HOSPITAL 4605 MACCORKLE AVE SW SOUTH CHARLESTON WV 25309 (304) 766-3600 190 510030 DAVIS MEMORIAL HOSPITAL PO BOX 1484 ELKINS WV 26241 (304) 636-3300 410 510031 ST FRANCIS HOSPITAL 333 LAIDLEY ST CHARLESTON WV 25301 (304) 347-6500 190 510033 ST JOSEPHS HOSPITAL 1824 MURDOCH AVENUE PARKERSBURG WV 26101 (304) 424-4382 530 510036 HAMPSHIRE MEMORIAL HOSPITAL PO BOX 555 549 CENTER AVENUE ROMNEY WV 26757 (304) 822-4561 130 510038 STONEWALL JACKSON MEM HOSP ROUTE 4 BOX 10 WESTON WV 26452 (304) 269-8080 200 510039 OHIO VALLEY MEDICAL CENTER 2000 EOFF STREET WHEELING WV 26003 (304) 234-0123 340 510043 POCAHONTAS MEMORIAL HOSPITAL RR 2 BOX 52 W BUCKEYE WV 24924 (304) 799-7400 370 510046 PRINCETON COMMUNITY HOSPITAL 12TH STREET PO BOX 1369 PRINCETON WV 24740 (304) 487-7000 270 510047 FAIRMONT GENERAL HOSPITAL 1325 LOCUST AVENUE FAIRMONT WV 26554 (304) 367-7100 240 510048 LOGAN GENL HOSP 20 HOSPITAL DR LOGAN WV 25601 (304) 752-1101 220 510050 WHEELING HOSPITAL MEDICAL PARK WHEELING WV 26003 (304) 243-3000 340 510052 CAMC WOMEN AND CHILDREN'S HOSPITAL 800 PENNSYLVANIA AVE CHARLESTON WV 25302 (304) 347-9200 190 510053 ST JOSEPH HOSPITAL AMALIA DRIVE BUCKHANNON WV 26201 (304) 472-2000 480 510055 CABELL-HUNTINGTON HOSPITAL INC 1340 HAL GREER BOULEVARD HUNTINGTON WV 25701 (304) 526-2000 50 510058 CAMDEN CLARK MEMORIAL HOSPITAL 800 GARFIELD AVE PARKERSBURG WV 26105 (304) 424-2111 530 510059 EYE & EAR CLINIC OF CHARLESTON,THE 1306 KANAWHA BL E CHARLESTON WV 25301 (304) 343-4371 190 510061 POTOMAC VALLEY HOSPITAL 167 SOUTH MINERAL STREET KEYSER WV 26726 (304) 788-3141 280 510062 BECKLEY APPALACHIAN REGIONAL HOSPITAL 306 STANAFORD ROAD BECKLEY WV 25801 (304) 255-3000 400 510067 ST LUKES HOSPITAL 1333 SOUTHVIEW DRIVE POB 1190 BLUEFIELD WV 24701 (304) 327-2911 270 510068 JEFFERSON MEMORIAL HOSPITAL 300 S PRESTON ST RANSON WV 25438 (304) 725-3411 180 510070 RALEIGH GENERAL HOSPITAL 1710 HARPER ROAD BECKLEY WV 25801 (304) 256-4100 400 510071 BLUEFIELD REGIONAL MEDICAL CENTER 500 CHERRY ST BLUEFIELD WV 24701 (304) 327-2511 270 510072 WETZEL COUNTY HOSPITAL PO BOX 610 #3 EAST BENJAMIN DRIVE NEW MARTINSVILLE WV 26155 (304) 455-1212 510 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 143 Provider ID Hospital Name Address City State ZIP Telephone County 510077 WILLIAMSON MEMORIAL HOSPITAL 859 ALDERSON STREET WILLIAMSON WV 25661 (304) 235-2500 290 510082 SUMMERSVILLE MEMORIAL HOSPITAL 400 FAIRVIEW HEIGHTS ROAD SUMMERSVILLE WV 26651 (304) 872-2891 330 510085 PUTNAM GENERAL HOSPITAL 1400 HOSPITAL DRIVE HURRICANE WV 25526 (304) 757-9800 390 510086 WELCH COMMUNITY HOSPITAL 454 MCDOWELL STREET WELCH WV 24801 (304) 436-8461 230 510088 PLATEAU MEDICAL CENTER 430 MAIN STREET OAK HILL WV 25901 (304) 469-8606 90 511300 BROADDUS HOSPITAL MANSFIELD HILL P O BOX 930 PHILIPPI WV 26416 (304) 457-1760 480 511301 WEBSTER COUNTY MEMORIAL HOSPITAL P O BOX 312 (MILLER MOUNTAIN DRIVE) WEBSTER SPRINGS WV 26288 (304) 847-5682 500 511302 GUYAN VALLEY HOSPITAL 396 DINGESS ST LOGAN WV 25601 (304) 792-1700 220 511303 MINNIE HAMILTON ROUTE 1 BOX 1-A GRANTSVILLE WV 26147 (304) 354-9244 60 511304 SISTERVILLE GENERAL HOSPITAL 314 SOUTH WELLS STREET SISTERSVILLE WV 26175 (304) 652-2611 470 511305 RICHWOOD AREA COMMUNITY HOSPITAL RIVERSIDE ADDITION RICHWOOD WV 26261 (304) 846-2573 330 511306 ROANE GENERAL HOSPITAL 200 HOSPITAL DRIVE SPENCER WV 25276 (304) 927-4444 430 511307 GRAFTON CITY HOSPITAL 500 MARKET STREET GRAFTON WV 26354 (304) 265-0400 450 511308 BRAXTON COUNTY MEMORIAL HOSPITAL 100 HOYLMAN DRIVE GASSAWAY WV 26624 (304) 364-5156 30 511309 MORGAN CTY WAR MEMORIAL 1124 FAIRFAX STREET BERKELEY SPRINGS WV 25411 (304) 258-1234 320 511310 SUMMERS COUNTY ARH HOSPITAL TERRACE STREET P O BOX 940 HINTON WV 25951 (304) 466-1000 440 511311 HAMPSHIRE MEMORIAL HOSPITAL 549 CENTER AVENUE ROMNEY WV 26757 (304) 822-4561 130 512002 SELECT SPECIALITY HOSPITAL 501 MORRIS STREET 3RD AND 4TH FLOORS CHARLESTON WV 25301 (304) 388-7909 190 513025 PETERSON REHAB HOSP AND GER C OHIO COUNTY WHEELING WV 26003 (304) 234-0500 340 513026 HEALTHSOUTH SOUTHERN HILLS REHAB HOS 120 12TH STREET PRINCETON WV 24740 (304) 487-8000 270 513027 HEALTHSOUTH WESTERN HILLS REHAB HOSP 3 WESTERN HILLS DR PARKERSBURG WV 26101 (304) 420-1300 530 513028 H/S REHAB HOSPITAL OF HUNTINGTON 6900 W COUNTRY CLUB DR PO BOX 1028 HUNTINGTON WV 25705 (304) 733-1060 50 513029 WEST VIRGINIA REHAB HOSP BARRON DRIVE INSTITUTE WV 25112 (304) 766-4696 190 513030 H/S MOUNTAINVIEW REGIONAL REHAB HOSP 1160 VAN VOORHIS ROAD MORGANTOWN WV 26504 (304) 598-1100 300 514001 HIGHLAND HOSP 300 56TH ST SE CHARLESTON WV 25304 (304) 925-4756 190 514008 RIVER PARK HOSPITAL 1230 SIXTH AVENUE HUNTINGTON WV 25701 (304) 526-9111 50 514009 MILDRED MITCHELL-BATEMAN HOSPITAL 1530 NORWAY AVENUE HUNTINGTON WV 25709 (304) 525-7801 490 514010 WILLIAM R SHARPE HOSPITAL AT WESTON DRAWER 1127 WESTON WV 26452 (304) 269-1210 200 520002 ST MICHAELS HOSPITAL 900 ILLINOIS AVENUE STEVENS POINT WI 54481 (715) 346-5000 480 520003 MYRTLE WERTH HOSPITAL MAYO HEALTH SYST 2321 STOUT RD MENOMONIE WI 54751 (715) 235-5531 160 520004 FRANCISCAN SKEMP MED CTR LACROSSE 700 WEST AVE SOUTH LA CROSSE WI 54601 (608) 785-0940 310 520008 WAUKESHA MEMORIAL HOSPITAL INC 725 AMERICAN AVE WAUKESHA WI 53186 (414) 544-2011 660 520009 ST ELIZABETH HOSPITAL 88 1506 S ONEIDA ST APPLETON WI 54915 (414) 738-2000 430 520010 RIVER FALLS AREA HOSPITAL 1629 E DIVISION STREET RIVER FALLS WI 54022 (715) 425-6155 460 520011 LAKEVIEW MEDICAL CENTER 1100 N MAIN ST RICE LAKE WI 54868 (715) 234-1515 20 520013 SACRED HEART HOSPITAL 900 W CLAIREMONT AVE EAU CLAIRE WI 54701 (715) 839-4121 170 520014 STOUGHTON HOSPITAL 900 RIDGE STREET STOUGHTON WI 53589 (608) 873-2250 120 520015 GOOD SAMARITAN HEALTH CTR OF MERRILL 601 S CENTER AVE MERRILL WI 54452 (715) 536-5511 340 520017 ST JOSEPHS HOSPITAL 2661 COUNTY TRUNK I CHIPPEWA FALLS WI 54729 (715) 723-1811 80 520019 ST MARYS HOSPITAL 1044 KABEL AVENUE RHINELANDER WI 54501 (715) 369-6600 420 520021 UNITED HOSP SYS KENOSHA MED CTR 6308 EIGHTH AVENUE KENOSHA WI 53143 (414) 656-2011 290 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 144 Provider ID Hospital Name Address City State ZIP Telephone County 520024 VERNON MEMORIAL HOSPITAL 148 507 SOUTH MAIN STREET VIROQUA WI 54665 (608) 637-2101 610 520025 WAUPUN MEMORIAL HOSPITAL 620 W BROWN ST WAUPUN WI 53963 (414) 324-5581 190 520026 HOLY FAMILY HOSPITAL 535 HOSPITAL ROAD NEW RICHMOND WI 54017 (715) 246-2101 540 520027 ST MARYS HOSPITAL OZAUKEE INC 246 13111 N PORT WASHINGTON RD MEQUON WI 53097 (414) 243-7300 440 520028 MONROE CLINIC INC THE 515 22ND AVENUE MONROE WI 53566 (608) 324-1000 220 520030 WAUSAU HOSPITAL 333 PINE RIDGE BLVD WAUSAU WI 54401 (715) 847-2278 360 520032 UPLAND HILLS HEALTH 800 COMPASSION WAY DODGEVILLE WI 53533 (608) 935-2711 240 520033 RIVERVIEW HOSPITAL ASSOCIATION 410 DEWEY ST PO BOX 8080 WISCONSIN RAPIDS WI 54495 (715) 423-6060 700 520034 AURORA MEDICAL CTR 85 5000 MEMORIAL DRIVE TWO RIVERS WI 54241 (414) 793-1178 350 520035 SHEBOYGAN MEMORIAL MEDICAL CENTER 2629 N 7TH ST SHEBOYGAN WI 53083 (414) 451-5000 580 520037 ST JOSEPHS HOSPITAL 611 ST JOSEPH AVENUE MARSHFIELD WI 54449 (715) 387-7850 700 520038 AURORA MEDICAL CTR OF WASHINGTON CTY 1032 E SUMNER ST HARTFORD WI 53027 (414) 673-2300 650 520039 RUSK COUNTY MEMORIAL HOSPITAL 203 900 COLLEGE AVE WEST LADYSMITH WI 54848 (715) 532-5561 530 520040 ST MICHAEL HOSPITAL 54 2400 W VILLARD AVE MILWAUKEE WI 53209 (414) 527-8000 390 520041 DIVINE SAVIOR HEALTHCARE 80 1015 W PLEASANT ST PO BOX 387 PORTAGE WI 53901 (608) 742-4131 100 520042 REEDSBURG AREA MEDICAL CTR 179 2000 NORTH DEWEY AVENUE REEDSBURG WI 53959 (608) 524-6487 550 520044 ST NICHOLAS HOSPITAL 1601 N TAYLOR DR SHEBOYGAN WI 53081 (414) 459-8300 580 520045 THEDA CLARK MEMORIAL HOSPITAL 130 2ND ST NEENAH WI 54956 (414) 729-3100 690 520047 SPOONER HEALTH SYSTEM 84 819 ASH STREET SPOONER WI 54801 (715) 635-2111 640 520048 MERCY MEDICAL CENTER OF OSHKOSH INC 631 HAZEL ST OSHKOSH WI 54901 (414) 236-2000 690 520049 BELLIN MEMORIAL HOSPITAL 744 S WEBSTER AVE P O BOX 23400 GREEN BAY WI 54301 (414) 433-3500 40 520051 ST MARYS HOSPITAL OF MILWAUKEE 53 2323 N LAKE DRIVE MILWAUKEE WI 53211 (414) 291-1000 390 520053 NEW LONDON FAMILY MEDICAL CTR INC 1405 MILL ST PO BOX 307 NEW LONDON WI 54961 (414) 982-5330 430 520057 ST CLARE HOSPITAL AND HEALTH SERVICES 707 14TH STREET BARABOO WI 53913 (608) 356-5561 550 520058 ST MARYS HOSPITAL OF SUPERIOR NO 63 3500 TOWER AVE SUPERIOR WI 54880 (715) 392-8281 150 520059 MEMORIAL HOSPITAL CORP OF BURLINGTON 252 MCHENRY STREET BURLINGTON WI 53105 (414) 763-2411 500 520060 BERLIN MEMORIAL HOSPITAL 225 MEMORIAL DRIVE BERLIN WI 54923 (414) 361-1313 230 520062 OCONOMOWOC MEMORIAL HOSPITAL 791 E SUMMIT AUENUE OCONOMOWOC WI 53066 (414) 569-0904 660 520063 ST JOSEPHS COMMUNITY HOSP OF WEST BEND 551 SO SILVERBROOK DRIVE WEST BEND WI 53095 (414) 334-5533 650 520066 MERCY HEALTH SYSTEM CORP 1000 MINERAL POINT AVENUE JANESVILLE WI 53545 (608) 756-6000 520 520068 CUMBERLAND MEM HSPTL EXTENDED CARE 1110 7TH AVE CUMBERLAND WI 54829 (715) 822-2741 20 520070 LUTHER HOSPITAL 1221 WHIPPLE ST EAU CLAIRE WI 54702 (715) 839-3311 170 520071 FORT ATKINSON MEMORIAL HEALTH SERVICES 611 SHERMAN AVENUE EAST FORT ATKINSON WI 53538 (920) 568-5000 270 520075 ST VINCENT HOSPITAL 835 S VAN BUREN P O BOX 13508 GREEN BAY WI 54307 (414) 433-0111 40 520076 BEAVER DAM COMMUNITY HOSPITAL INC 707 S UNIVERSITY AVE BEAVER DAM WI 53916 (920) 887-5994 130 520078 ST FRANCIS HOSPITAL INC 3237 SOUTH 16TH STREET MILWAUKEE WI 53215 (414) 647-5000 390 520083 ST MARYS HOSPITAL MEDICAL CENTER 707 SOUTH MILLS STREET MADISON WI 53715 (608) 258-6100 120 520084 COLUMBUS COMMUNITY HOSPITAL 1515 PARK AVENUE COLUMBUS WI 53925 (920) 623-2200 100 520087 LA CROSSE LUTHERAN HOSPITAL 1910 SO AVENUE LA CROSSE WI 54601 (608) 785-0530 310 520088 ST AGNES HOSPITAL 430 EAST DIVISON STREET FOND DU LAC WI 54935 (414) 929-2300 190 520089 MERITER HOSPITAL INC 202 S PARK ST MADISON WI 53715 (608) 267-6000 120 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 145 Provider ID Hospital Name Address City State ZIP Telephone County 520091 HOWARD YOUNG MEDICAL CENTER 240 MAPLE ST PO BOX 470 WOODRUFF WI 54568 (715) 356-8000 420 520092 SHAWANO MEDICAL CTR 36 309 N BARTLETTE ST SHAWANO WI 54166 (715) 526-2111 570 520094 ALL SAINTS ST LUKES HOSPITAL 94 1320 WISCONSIN AVE RACINE WI 53403 (414) 636-2011 500 520095 SAUK PRAIRIE MEMORIAL HOSPITAL 80 1ST ST PRAIRIE DU SAC WI 53578 (608) 643-3311 550 520096 ALL SAINTS ST MARYS MED CTR 96 3801 SPRING ST RACINE WI 53405 (414) 636-4211 500 520097 ST MARYS HOSPITAL MEDICAL CENTER 1726 SHAWANO AVENUE GREEN BAY WI 54303 (414) 498-4200 40 520098 UNIV OF WI HOSPITALS/CLINICS AUTHORITY 600 HIGHLAND AVE MADISON WI 53705 (608) 263-6400 120 520100 BELOIT MEMORIAL HOSPITAL INC 1969 WEST HART ROAD BELOIT WI 53511 (608) 364-5011 520 520102 AURORA LAKELAND MEDICAL CTR W3985 COUNTY RD NN PO BOX 1002 ELKHORN WI 53121 (414) 741-2000 630 520103 COMMUNITY MEMORIAL HOSPITAL W180 N8085 TOWN HALL RD MENOMONEE FALLS WI 53051 (414) 251-1000 660 520107 HOLY FAMILY MEMORIAL MEDICAL CENTER 2300 WESTERN AVENUE MANITOWOC WI 54220 (414) 684-2210 350 520109 HESS MEMORIAL HOSPITAL INC 1050 DIVISION ST MAUSTON WI 53948 (608) 847-6161 280 520112 ST CROIX REGIONAL MEDICAL CTR INC 204 S ADAMS ST ST CROIX FALLS WI 54024 (715) 483-3261 470 520113 BAY AREA MEDICAL CENTER MARINETTE 3100 SHORE DRIVE MARINETTE WI 54143 (715) 735-6621 370 520114 BOSCOBEL AREA HEALTH CARE 205 PARKER STREET BOSCOBEL WI 53805 (608) 375-4112 210 520116 WATERTOWN MEMORIAL HOSPITAL 125 HOSPITAL DRIVE WATERTOWN WI 53098 (414) 261-4210 270 520117 RICHLAND HOSPITAL INC THE 333 E SECOND ST RICHLAND CENTER WI 53581 (608) 647-6321 510 520123 BALDWIN AREA MEDICAL CTR 141 730 10TH AVE PO BOX 300 BALDWIN WI 54002 (715) 684-3311 540 520130 BURNETT MEDICAL CENTER INC 205 257 W ST GEORGE AVE GRANTSBURG WI 54840 (715) 463-5353 60 520131 FLAMBEAU HOSPITAL INC 98 SHERRY AVE PO BOX 310 PARK FALLS WI 54552 (715) 762-2484 490 520132 VALLEY VIEW MEDICAL CTR 901 REED STREET PLYMOUTH WI 53073 (414) 893-1771 580 520134 PRAIRIE DU CHIEN MEMORIAL HOSPITAL 705 EAST TAYLOR STREET PRAIRIE DU CHIEN WI 53821 (608) 326-2431 110 520135 INDIANHEAD MEDICAL CTR SHELL LAKE 113 4TH AVE PO BOX 300 SHELL LAKE WI 54871 (715) 468-7833 640 520136 ST JOSEPH REGIONAL MEDICAL CTR 5000 W CHAMBERS ST MILWAUKEE WI 53210 (414) 447-2130 390 520138 ST LUKES MEDICAL CENTER INC 2900 W OKLAHOMA AVE MILWAUKEE WI 53215 (414) 649-6000 580 520139 WEST ALLIS MEMORIAL HOSPITAL 8901 WEST LINCOLN AVENUE WEST ALLIS WI 53227 (414) 328-6000 390 520140 COLUMBIA HOSPITAL INC 2025 EAST NEWPORT AVENUE MILWAUKEE WI 53211 (414) 961-3638 390 520148 LANGLADE MEMORIAL HOSPITAL 117 112 EAST FIFTH AVENUE ANTIGO WI 54409 (715) 623-2331 330 520151 BLACK RIVER MEMORIAL HOSPITAL 711 W ADAMS ST BLACK RIVER FALLS WI 54615 (715) 284-5361 260 520152 DOOR COUNTY MEMORIAL HOSPITAL 144 323 SOUTH 18TH AVENUE STURGEON BAY WI 54235 (920) 743-5566 140 520154 RIVERSIDE MEDICAL CTR 800 RIVERSIDE DR WAUPACA WI 54981 (715) 258-1008 670 520156 HUDSON HOSPITAL 400 WISCONSIN STREET HUDSON WI 54016 (715) 386-9321 540 520160 APPLETON MEDICAL CENTER 1818 NORTH MEADE STREET APPLETON WI 54911 (414) 731-4101 430 520161 HAYWARD AREA MEMORIAL HOSPITAL 11040 NORTH STATE RD 77 HAYWARD WI 54843 (715) 634-8911 560 520170 ELMBROOK MEMORIAL HOSPITAL 19333 WEST NORTH AVENUE BROOKFIELD WI 53045 (414) 785-2000 660 520173 MEMORIAL MEDICAL CENTER INC 1615 MAPLE LANE ASHLAND WI 54806 (715) 682-1154 10 520177 FROEDTERT MEMORIAL LUTHERAN HOSPITAL 9200 W WISCONSIN AVE MILWAUKEE WI 53226 (414) 259-3000 390 520178 SOUTHWEST HEALTH CENTER INC 250 CAMP ST PLATTEVILLE WI 53818 (608) 348-2331 210 520189 AURORA MEDICAL CTR KENOSHA 10400 75TH ST KENOSHA WI 53142 (414) 697-7000 290 520193 AURORA BAYCARE MEDICAL CTR 2845 GREENBRIER RD PO BOX 8900 GREEN BAY WI 54311 (920) 288-3003 40 520194 ORTHOPAEDIC HOSPITAL OF WISCONSIN 575 W RIVER WOODS PARKWAY GLENDALE WI 53212 (414) 961-6800 390 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 146 Provider ID Hospital Name Address City State ZIP Telephone County 520195 COLUMBIA CENTER, LLC 2025 E NEWPORT AVENUE, SUITE 3000 MILWAUKEE WI 53211 (414) 961-3590 390 520196 OAK LEAF SURGICAL HOSPITAL 3802 OAKWOOD MALL DRIVE EAU CLAIRE WI 54701 (715) 831-8130 170 521300 EAGLE RIVER MEMORIAL HOSPITAL 201 HOSPITAL RD EAGLE RIVER WI 54521 (715) 479-7411 620 521301 OCONTO MEMORIAL HOSPITAL 405 FIRST ST OCONTO WI 54153 (920) 834-8800 410 521302 OSSEO AREA MEDICAL CTR 13025 8TH ST PO BOX 70 OSSEO WI 54758 (715) 597-3121 600 521303 WILD ROSE COMMUNITY MEMORIAL HOSPITAL 601 GROVE AVE PO BOX 243 WILD ROSE WI 54984 (414) 622-3257 680 521304 ST JOSEPHS COMMUNITY HEALTH SERV INC 400 WATER AVE PO BOX 527 HILLSBORO WI 54634 (608) 489-2211 610 521305 FRANCISCAN SKEMP MED CTR SPARTA HOSP 310 W MAIN ST SPARTA WI 54656 (608) 269-2132 400 521306 FRANCISCAN SKEMP MED CTR-ARCADIA HOSP 464 S ST JOSEPHS AVE ARCADIA WI 54612 (608) 323-3341 600 521307 CHIPPEWA VALLEY HOSPITAL 1220 3RD AVE W PO BOX 224 DURAND WI 54736 (715) 672-4211 450 521308 AMERY REGIONAL MEDICAL CTR 225 SCHOLL COURT AMERY WI 54001 (715) 268-1300 470 521309 ADAMS CTY MEMORIAL HOSPITAL 402 W LAKE ST PO BOX 40 FRIENDSHIP WI 53934 (608) 339-3331 0 521310 COMMUNITY MEMORIAL HOSPITAL 855 S MAIN ST OCONTO FALLS WI 54154 (920) 846-3444 410 521311 VICTORY MEDICAL CTR INC 230 E FOURTH AVE STANLEY WI 54768 (715) 644-6148 80 521312 MEMORIAL HOSPITAL LAFAYETTE CTY 800 CLAY ST PO BOX 70 DARLINGTON WI 53530 (608) 776-4466 320 521313 SACRED HEART HOSPITAL 216 N 7TH ST TOMAHAWK WI 54487 (715) 453-7700 340 521314 BLOOMER MEDICAL CTR 1501 THOMPSON ST BLOOMER WI 54724 (715) 568-2000 80 521315 BARRON MEMORIAL MEDICAL CENTER MAYO 1222 E WOODLAND AVENUE BARRON WI 54812 (715) 537-3186 20 521316 TRI COUNTY MEMORIAL HOSPITAL 18601 LINCOLN ST PO BOX 65 WHITEHALL WI 54773 (715) 538-4361 600 521317 CALUMET MEDICAL CENTER 614 MEMORIAL DRIVE CHILTON WI 53014 (920) 849-8104 70 521318 OSCEOLA MEDICAL CENTER 301 RIVER ST PO BOX 218 OSCEOLA WI 54020 (715) 294-2111 540 521319 MEMORIAL COMMUNITY HOSPITAL 313 STOUGHTON ROAD EDGERTON WI 53534 (608) 884-1669 520 521320 TOMAH MEMORIAL HOSPITAL 321 BUTTS AVENUE TOMAH WI 54660 (608) 312-2181 400 521321 RIPON MEDICAL CTR 933 NEWBURY ST PO BOX 390 RIPON WI 54971 (920) 748-3101 190 521322 GRANT REGIONAL HEALTH CENTER 507 S MONROE STREET LANCASTER WI 53813 (608) 723-3202 210 521323 MEMORIAL HOSPITAL INC 216 SUNSET PLACE NEILLSVILLE WI 54456 (715) 743-3101 90 521324 MEMORIAL HEALTH CENTER INC 135 S GIBSON STREET MEDFORD WI 54451 (715) 748-8100 590 522004 KINDRED HOSPITAL MILWAUKEE 274 5017 S 110TH ST GREENFIELD WI 53228 (414) 427-8282 390 522005 LAKEVIEW NEUROREHAB CTR MIDWEST 272 1701 SHARP RD WATERFORD WI 53185 (414) 534-2301 500 522006 SELECT SPECIALTY HOSPITAL - MILWAUKEE 8901 W LINCOLN AVE WEST ALLIS WI 53227 (402) 351-2273 390 522007 LIFECARE HOSPITALS OF MILWAUKEE 2400 W VILLARD AVE 3RD FL SOUTH MILWAUKEE WI 53209 (512) 302-3232 390 523025 SACRED HEART REHAB INSTITUTE 2350 NORTH LAKE DRIVE MILWAUKEE WI 53211 (414) 383-4490 390 523300 CHILDREN'S HOSPITAL OF WISCONSIN 9000 W WISCONSIN AVE PO BOX 1997 MILWAUKEE WI 53201 (414) 266-2000 390 523301 CHILDREN'S HOSPITAL OF WI-KENOSHA 6308 8TH AVENUE KENOSHA WI 53143 (414) 344-8111 290 523302 CHILDRENS HOSPITAL OF WI FOX VALLEY 130 SECOND STREET NEENAH WI 54956 (920) 729-3100 690 524000 AURORA PSYCHIATRIC HOSPITAL 1220 DEWEY AVENUE WAUWATOSA WI 53213 (414) 454-6600 390 524001 MILWAUKEE CO MENTAL HEALTH COMPLEX 9455 W WATERTOWN PLANK ROAD MILWAUKEE WI 53226 (414) 257-5202 390 524002 WINNEBAGO MENTAL HEALTH INSTITUTE 250 BUTLER AVE AT SHERMAN AVE PO BOX 9 WINNEBAGO WI 54985 (414) 235-4910 690 524008 MENDOTA MENTAL HEALTH INSTITUTE 301 TROY DR MADISON WI 53704 (608) 301-1000 120 524014 BROWN COUNTY MENTAL HEALTH CTR 213 2900 ST ANTHONY DRIVE GREEN BAY WI 54311 (920) 391-4700 40 524017 NORTH CENTRAL HEALTH CARE FACIL 206 1100 LAKEVIEW DRIVE WAUSAU WI 54403 (715) 848-4600 360 Provider of Services File Centers for Medicare and Medicaid Services September, 2002 / Page 147 Provider ID Hospital Name Address City State ZIP Telephone County 524018 ROGERS MEMORIAL HOSP 34700 VALLEY ROAD OCONOMOWOC WI 53066 (414) 646-4411 660 524019 NORWOOD HEALTH CTR 211 1600 NORTH CHESTNUT AVE MARSHFIELD WI 54449 (715) 384-2188 700 524025 FOND DU LAC CTY ACUTE PSYCH UNIT 231 459 E FIRST STREET FOND DU LAC WI 54935 (920) 929-3500 190 524026 WAUKESHA COUNTY MENTAL HEALTH CTR 218 1501 AIRPORT ROAD WAUKESHA WI 53188 (262) 548-7950 660 524038 BELLIN PSYCHIATRIC CENTER INC 301 E ST JOSEPH STREET GREEN BAY WI 54301 (414) 433-3630 40 530002 CAMPBELL COUNTY MEMORIAL HOSPITAL 501 S BURMA AVE/PO BOX 3011 GILLETTE WY 82716 (307) 687-5553 20 530004 HOT SPRINGS COUNTY MEMORIAL HOSPITAL 150 E ARAPAHOE THERMOPOLIS WY 82443 (307) 864-3121 80 530006 MEMORIAL HOSPITAL OF SHERIDAN COUNTY 1401 W 5TH ST SHERIDAN WY 82801 (307) 672-1000 160 530007 POWELL HOSPITAL 777 AVE H POWELL WY 82435 (307) 754-2267 140 530008 RIVERTON MEMORIAL HOSPITAL 2100 W SUNSET DR RIVERTON WY 82501 (307) 856-4161 60 530009 MEMORIAL HOSPITAL OF CARBON COUNTY 2221 ELM ST PO BOX 460 RAWLINS WY 82301 (307) 324-2221 30 530010 LANDER VALLEY MEDICAL CENTER 1320 BISHOP RANDALL DR LANDER WY 82520 (307) 332-4420 60 530011 MEMORIAL HOSPITAL SWEETWATER COUNTY 1200 COLLEGE DR/PO BOX 1359 ROCK SPRINGS WY 82901 (307) 362-3711 180 530012 WYOMING MEDICAL CENTER 1233 EAST 2ND ST CASPER WY 82601 (307) 577-7201 120 530014 UNITED MEDICAL CENTER 21 EAST 23RD STREET CHEYENNE WY 82001 (307) 634-2273 100 530015 ST JOHNS HOSPITAL 625 E BROADWAY, PO BOX 428 JACKSON WY 83001 (307) 733-3636 190 530016 WEST PARK HOSPITAL DISTRICT 707 SHERIDAN AVE CODY WY 82414 (307) 527-7501 140 530017 SOUTH LINCOLN MEDICAL CENTER 711 ONYX STREET/PO BOX 390 KEMMERER WY 83101 (307) 877-4401 110 530018 COMMUNITY HOSPITAL 2000 CAMPBELL DR TORRINGTON WY 82240 (307) 532-4181 70 530019 PLATTE COUNTY MEMORIAL HOSPITAL 201 14TH ST, PO DRAWER 848 WHEATLAND WY 82201 (307) 322-3636 150 530022 WASHAKIE MEDICAL CENTER 400 SOUTH 15TH ST, PO BOX 700 WORLAND WY 82401 (307) 347-3221 210 530023 STAR VALLEY MEDICAL CENTER 110 HOSPITAL LANE PO BOX 579 AFTON WY 83110 (307) 885-5800 110 530025 IVINSON MEMORIAL HOSPITAL 255 N 30TH LARAMIE WY 82070 (307) 742-2141 0 530026 JOHNSON CO MEMORIAL HOSP 497 W LOTT ST BUFFALO WY 82834 (307) 684-5521 90 530029 NORTH BIG HORN HOSPITAL 1115 LANE 12 LOVELL WY 82431 (307) 548-2771 10 530031 CROOK COUNTY MEMORIAL HOSPITAL 713 OAK ST, PO BOX 517 SUNDANCE WY 82729 (307) 283-3501 50 530032 EVANSTON REGIONAL HOSPITAL 190 ARROWHEAD DR EVANSTON WY 82930 (307) 789-3636 200 531301 SOUTH BIG HORN COUNTY HOSPITAL-CAH 388 SOUTH US HIGHWAY 20 GREYBULL WY 82426 (307) 568-3311 10 531302 MEMORIAL HOSPITAL OF CONVERSE COUNTY 111 SOUTH 5TH STREET PO BOX 1450 DOUGLAS WY 82633 (307) 358-2122 40 531303 WESTON COUNTY HEALTH SERVICES 1124 WASHINGTON BOULEVARD NEWCASTLE WY 82701 (307) 746-4491 220 532002 WYOMING STATE HOSPITAL 831 HIGHWAY 150 SOUTH/PO BOX 177 EVANSTON WY 82930 (307) 789-3464 200 534001 WYOMING STATE HOSPITAL-CAMPBELL HALL 831 S HIGHWAY 150 PO BOX 177 EVANSTON WY 82931 (307) 789-3464 200 534004 WYOMING BEHAVIORAL INSTITUTE 2521 EAST 15TH STREET CASPER WY 82609 (307) 237-7444 120 640001 LBJ TROPICAL MEDICAL CENTER PAGO PAGO PAGO PAGO AS 96799 (684) 633-1222 60 650001 GUAM MEMORIAL AUTHORITY HOSPITAL 85O GOV CARLOS G CAMACHO ROAD TAMUNING GU 96911 (671) 647-2552 180 660001 COMMONWEALTH HEALTH CENTER PO BOX 409 CK (NAVY HILL ROAD) SAIPAN MARIANA ISLANMP 96950 (670) 234-8950 0 650001 GUAM MEMORIAL AUTHORITY HOSPITAL 85O GOV CARLOS G CAMACHO ROAD TAMUNING GU 96911 (671) 647-2552 180 660001 COMMONWEALTH HEALTH CENTER PO BOX 409 CK (NAVY HILL ROAD) SAIPAN MARIANA ISLANMP 96950 (670) 234-8950 0