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DSH100017D HALIFAX HEALTH MEDICAL CENTER (Active)
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Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
Halifax Health Center for Oncology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017D
Medicare Provider Number
100017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/4/2012
Participating Start Date
7/1/2012
Participating Approval Date
6/21/2012
Last Recertification Date
8/28/2024
Contacts
Authorizing Official
Halifax Hospital Medical Center
Alberto J Tineo, Chief Operating Officer
(386) 425-4073
Primary Contact
Halifax Health Medical Center
Crystal A Lue, Director, Reimbursement and Revenue
(386) 425-7382
Addresses
Street Address
1185 Dunlawton Ave. Suite 105
Port Orange, FL 32127
Billing Address
Halifax Health Medical Center
303 North Clyde Morris Blvd.
Daytona Beach, FL 32114
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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