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DSH190002R LAFAYETTE GENERAL MEDICAL CENTER (Terminated)
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Main Details
Name
LAFAYETTE GENERAL MEDICAL CENTER
Subdivision Name
LGO Hyperbarics
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190002R
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
8/21/2019
Termination Date
Termination Reason
7/1/2020
Site closure
Contacts
Authorizing Official
Lafayette General Medical Center
al jude patin, SVP, Chief Operating Officer
(337) 289-7743
Primary Contact
Lafayette General Medical Center
Daniel Robinson, Director 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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