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DSH190002 LAFAYETTE GENERAL MEDICAL CENTER (Active)
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Main Details
Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190002
Medicare Provider Number
190002
Additional Details
Current Program Status
Active
Registration Date
10/25/2005
Participating Start Date
10/25/2005
Participating Approval Date
10/25/2005
Last Recertification Date
9/3/2024
Contacts
Authorizing Official
Lafayette General Medical Center
Al Jude Patin, Chief Executive Officer
(337) 354-9334
Primary Contact
OLG Lafayette General Medical Center
Caleb Stephenson, Director - Pharmacy
(337) 289-7853
Addresses
Street Address
1214 COOLIDGE STREET
LAFAYETTE, LA 70503
Billing Address
Ochsner Clinic Foundation - Accounts Payable
1201 Dickory Ave
New Orleans, LA 70123
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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