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DSH190005S University Medical Center Management Corporation d/b/a Interim LSU Hospital (Terminated)
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Main Details
Name
University Medical Center Management Corporation d/b/a Interim LSU Hospital
Subdivision Name
Podiatry Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190005S
Medicare Provider Number
190005
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
10/3/2013
Participating Start Date
1/1/2014
Participating Approval Date
11/17/2013
Last Recertification Date
8/19/2015
Termination Date
Termination Reason
1/1/2016
Site closure
Contacts
Authorizing Official
UMCNO
Lisa Miranda, Chief Operating Officer
(504) 702-4411
Primary Contact
Anthony Laurent, Pharmacy Director
(504) 903-3022
Addresses
Street Address
1400 Poydras St.
New Orleans, LA 70112
Billing Address
University Medical Center Management Corporation d/b/a Interim LSU Hospital
2021 Perdido St.
New Orleans, LA 70112
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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