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DSH190020C LANE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
LANE REGIONAL MEDICAL CENTER
Subdivision Name
Lane Cancer Center
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190020C
Medicare Provider Number
190020
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/14/2015
Participating Start Date
1/1/2016
Participating Approval Date
11/23/2015
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Lane Regional Medical Center
Frank Corcoran, CEO
(225) 658-4303
Primary Contact
Lane Regional Medical Center
Jassoni Shae Martin, Director of Pharmacy
(225) 658-4364
Addresses
Street Address
6180 Main Street, Suite A
Zachary, LA 70791
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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