Provider Demographics
NPI:1609234012
Name:SAVOY MEDICAL MANAGEMENT GROUP, INC
Entity Type:Organization
Organization Name:SAVOY MEDICAL MANAGEMENT GROUP, INC
Other - Org Name:BASILE RURAL HEALTH CLINIC
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:337-432-0200
Mailing Address - Fax:337-432-0202
Practice Address - Street 1:1431 FUSELIER AVE
Practice Address - Street 2:
Practice Address - City:BASILE
Practice Address - State:LA
Practice Address - Zip Code:70515-5583
Practice Address - Country:US
Practice Address - Phone:337-432-0200
Practice Address - Fax:337-432-0202
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAVOY MEDICAL MANAGEMENT GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-01
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2203783121261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2455478Medicaid
LA193924OtherMEDICARE RHC CCN