Healthcare Provider Details

I. General information

NPI: 1306172085
Provider Name (Legal Business Name): SAVOY MEDICAL MANAGEMENT GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S 2ND ST
EUNICE LA
70535
US

IV. Provider business mailing address

801 POINCIANA AVE
MAMOU LA
70554-2243
US

V. Phone/Fax

Practice location:
  • Phone: 337-457-3135
  • Fax: 337-457-2904
Mailing address:
  • Phone: 337-468-0355
  • Fax: 337-468-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number148
License Number StateLA

VIII. Authorized Official

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