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DSH190002C LAFAYETTE GENERAL MEDICAL CENTER (Active)
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Main Details
Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
G I Lab LGMH CB11 - OLGH BRACC ENDO PRE/POST-OP
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190002C
Medicare Provider Number
190002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
4/12/2013
Participating Start Date
7/1/2013
Participating Approval Date
6/11/2013
Last Recertification Date
8/30/2024
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
1211 Coolidge Street
Suite 402
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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