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DSH190102AS OUR LADY OF LOURDES RMC (Active)
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Main Details
Name
OUR LADY OF LOURDES RMC
Subdivision Name
Lourdes Breast Center - Imaging Services
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH190102AS
Medicare Provider Number
190102
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/16/2023
Participating Start Date
4/1/2023
Participating Approval Date
1/30/2023
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
2311 KALISTE SALOOM ROAD
Lafayette, LA 70508
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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