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DSH190041A CHRISTUS Health Shreveport-Bossier (Terminated)
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Main Details
Name
CHRISTUS Health Shreveport-Bossier
Subdivision Name
CHRISTUS Highland Medical Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190041A
Medicare Provider Number
190041
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
1/9/2006
Participating Start Date
4/1/2006
Participating Approval Date
1/11/2006
Last Recertification Date
8/24/2015
Termination Date
Termination Reason
7/1/2016
Site closure
Contacts
Authorizing Official
CHRISTUS Shreveport-Bossier
Bryan Pannagl, Chief Financial Officer
(318) 681-5444
Primary Contact
CHRISTUS Health
Scott Merryman, EVP/CFO
(318) 561-7172
Addresses
Street Address
1453 E BERT KOUNS INDUSTRIAL LOOP
SHREVEPORT, LA 71105
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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2/13/12 Chang AO from Touchet and PC Lowery to Wright and Merryman
01/09/2006
May 2025
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