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DSH100017X HALIFAX MEDICAL CENTER (Terminated)
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Main Details
Name
HALIFAX MEDICAL CENTER
Subdivision Name
Centers for Urology, Centers for Female Pelvic Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017X
Medicare Provider Number
100017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2015
Participating Start Date
10/1/2015
Participating Approval Date
7/16/2015
Last Recertification Date
Termination Date
Termination Reason
4/1/2016
Loss of qualifying grant/support
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 480
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
Parent/Child
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