Provider Demographics
NPI:1114236239
Name:SAVOY MEDICAL CENTER - PHYSICIANS
Entity Type:Organization
Organization Name:SAVOY MEDICAL CENTER - PHYSICIANS
Other - Org Name:SAVOY MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-468-0128
Mailing Address - Street 1:PO BOX 53008
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-3008
Mailing Address - Country:US
Mailing Address - Phone:337-468-5261
Mailing Address - Fax:337-468-3342
Practice Address - Street 1:801 POINCIANA AVE
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2243
Practice Address - Country:US
Practice Address - Phone:337-468-5261
Practice Address - Fax:337-468-3342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1796590Medicaid
5D046OtherMEDICARE PTAN