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DSH100017AM HALIFAX HEALTH MEDICAL CENTER (Terminated)
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Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
HALIFAX HEALTH MEDICAL CENTER - Deltona Freestanding ED
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017AM
Medicare Provider Number
100017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/3/2018
Participating Start Date
10/1/2018
Participating Approval Date
8/17/2018
Last Recertification Date
9/9/2019
Termination Date
Termination Reason
4/1/2020
Change of covered entity type (non-hospital)
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
3300 HALIFAX CROSSINGS BLVD
DELTONA, FL 32725-0001
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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