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DSH160067W MercyOne Waterloo Medical Center (Terminated)
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Main Details
Name
MercyOne Waterloo Medical Center
Subdivision Name
COVENANT CLINIC SHELL ROCK
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160067W
Medicare Provider Number
160067
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
2/28/2011
Participating Start Date
4/1/2011
Participating Approval Date
3/2/2011
Last Recertification Date
9/2/2018
Termination Date
Termination Reason
7/1/2019
Site closure
Contacts
Authorizing Official
MercyOne NorthEast Iowa
Timothy Huber, Vice President of Finance
(319) 272-7607
Primary Contact
MercyOne Northeast Iowa
Trish Means Neuroth, Reimbursement Accountant
(319) 272-7601
Addresses
Street Address
309 S CHERRY STREET
SHELL ROCK, IA 50670
Billing Address
COVENANT CLINIC
PO BOX 6200
WATERLOO, IA 50704
Comments
Medicaid Billing
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