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DSH100017T HALIFAX HEALTH MEDICAL CENTER (Active)
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Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
Interventional Pain Service
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017T
Medicare Provider Number
100017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/1/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/16/2015
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
201 N. Clyde Morris Blvd. , Suite 230
Daytona Beach, FL 32114
Billing Address
Halifax Health Medical Center
303 N CLYDE MORRIS BLVD
Daytona Beach, FL 32114
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
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