Healthcare Provider Details

I. General information

NPI: 1609234012
Provider Name (Legal Business Name): SAVOY MEDICAL MANAGEMENT GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2016
Last Update Date: 08/08/2022
Certification Date: 08/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1431 FUSELIER AVE
BASILE LA
70515-5583
US

IV. Provider business mailing address

801 POINCIANA AVE
MAMOU LA
70554-2243
US

V. Phone/Fax

Practice location:
  • Phone: 337-432-0200
  • Fax: 337-432-0202
Mailing address:
  • Phone: 337-432-0200
  • Fax: 337-432-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number2203783121
License Number StateLA

VIII. Authorized Official

Name: MR. MICHAEL W. JOHNSON
Title or Position: PRESIDENT
Credential: CPA
Phone: 337-468-0355