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DSH190098AU University Health Shreveport, LLC (Active)
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Main Details
Name
University Health Shreveport, LLC
Subdivision Name
Ortho & Sports Med OLSP OS01 - Olive Orthopedics and Sports Medicine Clinic
Type
Disproportionate Share Hospital
Rural
Yes
340B ID
DSH190098AU
Medicare Provider Number
190098
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
10/17/2022
Participating Start Date
1/1/2023
Participating Approval Date
10/24/2022
Last Recertification Date
9/5/2024
Contacts
Authorizing Official
Ochsner LSU
Christopher Eric Mangin, CEO
(318) 205-2245
Primary Contact
BRFHH Shreveport LLC
Jason D Lafitte, Director of Pharmacy
(318) 626-0863
Addresses
Street Address
950 Olive Street
Shreveport, LA 71104
Billing Address
Ochsner LSU Health Shreveport
1541 Kings Highway
Shreveport, LA 71103
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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