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DSH100017AE HALIFAX HEALTH MEDICAL CENTER (Active)
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Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
Halifax Health Port Orange GI Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017AE
Medicare Provider Number
100017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
10/28/2015
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
1041 Dunlawton Ave
Port Orange, FL 32127
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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