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DSH100017C HALIFAX HEALTH MEDICAL CENTER (Terminated)
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Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
Halifax Professional Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017C
Medicare Provider Number
100017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/4/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/21/2012
Last Recertification Date
8/31/2016
Termination Date
Termination Reason
10/1/2016
Site closure
Contacts
Authorizing Official
Halifax Hospital Medical Center
ERIC M. PEBURN, CFO
(386) 425-4568
Primary Contact
Halifax Health
Kern Dowsett, Reimbursement Specialist
(386) 425-4567
Addresses
Street Address
311 N Clyde Morris Blvd
Daytona Beach, FL 32114
Billing Address
Halifax Medical Center
303 N Clyde Morris BLvd
Daytona Beach, FL 32114
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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