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DSH100017AN HALIFAX HEALTH MEDICAL CENTER (Active)
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Main Details
Name
HALIFAX HEALTH MEDICAL CENTER
Subdivision Name
Care for Women - FHC - Halifax Health - Care for Women
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH100017AN
Medicare Provider Number
100017
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
7/14/2020
Participating Start Date
10/1/2020
Participating Approval Date
8/14/2020
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
201 N Clyde Morris Blvd.
Suite 110
Daytona Beach, FL 32114
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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