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DSH100017N HALIFAX HEALTH MEDICAL CENTER (Terminated)
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Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
Halifax Health- Eye Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017N
Medicare Provider Number
100017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/9/2015
Participating Start Date
7/1/2015
Participating Approval Date
5/14/2015
Last Recertification Date
8/30/2016
Termination Date
Termination Reason
1/1/2018
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
Suite 60
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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