Provider Demographics
NPI:1326349580
Name:SAVOY MEDICAL MANAGEMENT GROUP, INC
Entity Type:Organization
Organization Name:SAVOY MEDICAL MANAGEMENT GROUP, INC
Other - Org Name:MAMOU FAMILY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BURGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-468-0355
Mailing Address - Street 1:803 POINCIANA AVE, STE. C
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2201
Mailing Address - Country:US
Mailing Address - Phone:337-468-4038
Mailing Address - Fax:337-468-4042
Practice Address - Street 1:803 POINCIANA AVE
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554-2201
Practice Address - Country:US
Practice Address - Phone:337-468-4038
Practice Address - Fax:337-468-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-04
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPENDING261Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DS33OtherMEDICARE GROUP
LA198510OtherMEDICARE
LA2489291Medicaid