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DSH190020J LANE REGIONAL MEDICAL CENTER (Active)
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Main Details
Name
LANE REGIONAL MEDICAL CENTER
Subdivision Name
LANE OB/GYN-ZACHARY - Obstetrics and Gynecology
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190020J
Medicare Provider Number
190020
Outpatient Facility Provider Number
190020
Additional Details
Current Program Status
Active
Registration Date
4/14/2022
Participating Start Date
7/1/2022
Participating Approval Date
4/27/2022
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
6550 MAIN ST
STE 2000
ZACHARY, LA 70791-4092
Billing Address
Same as Street Address
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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May 2025
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