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DSH100017AD HALIFAX HEALTH MEDICAL CENTER (Active)
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Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
Halifax Health Port Orange Radiology-Diagnostics
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017AD
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
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