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DSH190098AN University Health Shreveport, LLC (Terminated)
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Main Details
Name
University Health Shreveport, LLC
Subdivision Name
Ochsner LSU Health Shreveport/ SHV MED DERM CLN
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190098AN
Medicare Provider Number
190098
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
4/13/2016
Participating Start Date
7/1/2016
Participating Approval Date
4/29/2016
Last Recertification Date
9/14/2020
Termination Date
Termination Reason
10/1/2021
Site closure
Contacts
Authorizing Official
Ochsner LSU Health Shreveport
Vernon Moore, Chief Financial Officer
(318) 626-0990
Primary Contact
BRFHH Shreveport LLC
Jason D Lafitte, Director of Pharmacy
(318) 626-0863
Addresses
Street Address
1606 KINGS HIGHWAY
Ochsner LSU Health Shreveport-AMBULATORY CARE CENTE
SHREVEPORT, LA 71103-4128
Billing Address
Ochsner LSU Health Shreveport
1541 Kings Highway
Shreveport, LA 71103
Comments
Medicaid Billing
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