Provider Demographics
NPI:1477882033
Name:SAVOY MEDICAL MANAGEMENT GROUP, INC.
Entity Type:Organization
Organization Name:SAVOY MEDICAL MANAGEMENT GROUP, INC.
Other - Org Name:SAVOY MEDICAL CENTER HOSPITAL BASED PHYSICIANS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:337-468-0355
Mailing Address - Street 1:801 POINCIANA AVE
Mailing Address - Street 2:
Mailing Address - City:MAMOU
Mailing Address - State:LA
Mailing Address - Zip Code:70554-2243
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
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:2009-12-10
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA673282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5DM80OtherMEDICARE PTAN
LA1796590Medicaid