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DSH160067AP MercyOne Waterloo Medical Center (Terminated)
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Main Details
Name
MercyOne Waterloo Medical Center
Subdivision Name
MercyOne Gladbrook Family Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160067AP
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
9/4/2023
Termination Date
Termination Reason
10/1/2024
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 2ND STREET
GLADBROOK, IA 50635
Billing Address
MercyOne Medical Group Northeast Iowa
PO BOX 6200
WATERLOO, IA 50704
Comments
Medicaid Billing
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Contract Pharmacies
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