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DSH050057M KAWEAH DELTA HEALTH CARE DISTRICT (Terminated)
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Main Details
Name
KAWEAH DELTA HEALTH CARE DISTRICT
Subdivision Name
THERAPY SPECIALISTS-ORTHOPEDICS AND SPORTS MEDICINE
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH050057M
Medicare Provider Number
050057
Outpatient Facility Provider Number
058508
Additional Details
Current Program Status
Terminated
Registration Date
2/9/2012
Participating Start Date
4/1/2012
Participating Approval Date
3/12/2012
Last Recertification Date
8/25/2014
Termination Date
Termination Reason
10/1/2015
Site closure
Contacts
Authorizing Official
Kaweah Delta Health Care District
GARY K. HERBST, Chief Executive Officer
(559) 624-2330
Primary Contact
Coby La Blue, DIRECTOR OF FINANCIAL AND LOGISTICAL PLANNING
(559) 624-2356
Addresses
Street Address
3362 South Fairway
Visalia, CA 93277
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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