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CAH451371-01 SETON EDGAR B. DAVIS HOSPITAL (Terminated)
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Main Details
Name
SETON EDGAR B. DAVIS HOSPITAL
Subdivision Name
SETON EDGAR B. DAVIS HOSPITAL SLEEP LAB
Type
Critical Access Hospital
Rural
No
340B ID
CAH451371-01
Medicare Provider Number
451371
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
8/19/2010
Participating Start Date
8/19/2010
Participating Approval Date
8/19/2010
Last Recertification Date
8/11/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
Seton Edgar B. Davis Hospital
Apryl Renee Haynes, COO/CNO
(830) 875-7041
Primary Contact
Seton Healthcare Family
Shewan M. Aziz, Senior Network Director of Pharmacy
(512) 324-7303
Addresses
Street Address
725 S. HACKBERRY AVE.
SUITE C
LULING, TX 78648-3200
Billing Address
SETON EDGAR B. DAVIS HOSPITAL
P.O. BOX 33034
SAN ANTONIO, TX 78265-3034
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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