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DSH160067M MercyOne Waterloo Medical Center (Terminated)
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Main Details
Name
MercyOne Waterloo Medical Center
Subdivision Name
MercyOne Waterloo Vascular Surgery
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160067M
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
9/12/2022
Termination Date
Termination Reason
10/1/2023
Other
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
2710 ST FRANCIS DRIVE
SUITE 410
WATERLOO, IA 50702
Billing Address
MercyOne Medical Group - Northeast Iowa
PO BOX 6200
SUITE 410
WATERLOO, IA 50704
Comments
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