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DSH160067CH MercyOne Waterloo Medical Center (Terminated)
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Main Details
Name
MercyOne Waterloo Medical Center
Subdivision Name
MercyOne Grand Crossing Family Medicine
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH160067CH
Medicare Provider Number
160067
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/7/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/21/2017
Last Recertification Date
9/13/2022
Termination Date
Termination Reason
10/1/2023
Other
Contacts
Authorizing Official
MercyOne NorthEast Iowa
Timothy Huber, Vice President of Finance
(319) 272-7607
Primary Contact
MercyOne Northeast Iowa
Trish Means Neuroth, Reimbursement Accountant
(319) 272-7601
Addresses
Street Address
21 W Jefferson St
Suite 103
Waterloo, IA 50701-1341
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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