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DSH190002W LAFAYETTE GENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
LGO Pre-Op
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190002W
Medicare Provider Number
190002
Outpatient Facility Provider Number
Additional Details
Current Program Status
Terminated
Registration Date
7/14/2017
Participating Start Date
10/1/2017
Participating Approval Date
7/24/2017
Last Recertification Date
8/29/2018
Termination Date
Termination Reason
10/1/2019
Outpatient facility moved within the 4 walls of the parent hospital
Contacts
Authorizing Official
Lafayette General Medical Center
al jude patin, SVP, Chief Operating Officer
(337) 289-7743
Primary Contact
Lafayette General Hospital
Philip Bruno, Director of Pharmacy
(337) 289-7888
Addresses
Street Address
2810 Ambassador Caffery Pkwy
Lafayette, LA 70506
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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