Provider Demographics
NPI:1801122585
Name:SAVOY MEDICAL MANAGEMENT GROUP, INC.
Entity type:Organization
Organization Name:SAVOY MEDICAL MANAGEMENT GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
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:337-746-0355
Mailing Address - Fax:337-468-3342
Practice Address - Street 1:1610 7TH ST
Practice Address - Street 2:
Practice Address - City:MAMOU
Practice Address - State:LA
Practice Address - Zip Code:70554
Practice Address - Country:US
Practice Address - Phone:337-468-0110
Practice Address - Fax:337-468-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-30
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA673E273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1705772Medicaid
LA19S025Medicare Oscar/Certification