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DSH190102AA OUR LADY OF LOURDES RMC (Active)
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Main Details
Name
OUR LADY OF LOURDES RMC
Subdivision Name
WOMEN'S AND CHILDREN'S REHAB SERVICE - REHAB SERVICES
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190102AA
Medicare Provider Number
190102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/14/2020
Participating Start Date
4/1/2020
Participating Approval Date
3/10/2020
Last Recertification Date
8/13/2024
Contacts
Authorizing Official
Our Lady of Lourdes Health
Jeremy Rogers, VP, Chief Financial Officer
(337) 470-2147
Primary Contact
Our Lady of Lourdes Regional Medical Center
Stacy Boatright, Director of Pharmacy
(337) 470-2111
Addresses
Street Address
4630 AMBASSADOR CAFFERY PKWY.
Building A
Suite 307
LAFAYETTE, LA 70508-6951
Billing Address
FMOLHS ACCOUNTS PAYABLE
PO BOX 83880
BATON ROUGE, LA 70884-3880
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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